scholarly journals AKI in Hospitalized Children: Poorly Documented (and Underrecognized)

2022 ◽  
Vol 9 ◽  
Author(s):  
Katherine Jones ◽  
Alicia Neu ◽  
Jeffrey Fadrowski
Keyword(s):  
Kidney Injury ◽  
The United States ◽  
Discharge Summary ◽  
Clinic Visit ◽  
Hospitalized Children ◽  
Progress Notes ◽  
Hospital Discharge Summary ◽  
Baseline Creatinine ◽  
Hospital Acquired

Background: Acute kidney injury (AKI) is common in hospitalized children. We hypothesized that hospital-acquired AKI would be underrecognized and under-reported, with potential implications for prevention of future AKI and CKD risk stratification.Methods: Five hundred thirty-two cases of AKI occurring over a 1 year period in a tertiary children's hospital in the United States were studied. AKI documentation was defined as any mention of AKI in the admission history and physical note, progress notes, or discharge summary. Nephrology follow-up was defined as a completed outpatient clinic visit within 1 year of discharge. Logistic regression was used to assess factors associated with documentation, consultation, and follow-up.Results: AKI developed during 584/7,640 (7.6%) of hospitalizations: 532 cases met inclusion criteria. Documentation was present in 34% (185/532) of AKI cases and 90 (16.9%) had an inpatient nephrology consult. Among 501 survivors, 89 (17.8%) had AKI in their hospital discharge summary and 54 had outpatient nephrology follow up. Stage 3 AKI, peak creatinine >1 mg/dL and longer length of stay were associated with documentation. Stage 3 AKI and higher baseline creatinine were associated with inpatient nephrology consultation. Inpatient nephrology consultation was positively associated with outpatient nephrology follow up, but documentation in the discharge summary was not.Conclusion: Most cases of AKI were not documented and the proportion of children seen by a nephrologist was low, even among those with more severe injury. Increased severity of AKI was associated with documentation and inpatient consultation. Poor rates of documentation has implications for AKI recognition and appropriate management and follow up.

scholarly journals Admission plasma uromodulin and the risk of acute kidney injury in hospitalized patients with cirrhosis: a pilot study

2019 ◽  
Vol 317 (4) ◽  
pp. G447-G452
Author(s):  
Kavish R. Patidar ◽  
Pranav S. Garimella ◽  
Etienne Macedo ◽  
James E. Slaven ◽  
Marwan S. Ghabril ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Predictive Biomarker ◽  
Hospitalized Patients ◽  
Susceptible Population ◽  
Baseline Creatinine ◽  
Low Levels ◽  
Time Of Admission ◽  
Hospital Acquired

Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as hospitalized patients with cirrhosis. Thus, we investigated whether plasma uromodulin measured at the time of admission is associated with subsequent hospital-acquired AKI (defined by a rise in serum creatinine >0.3mg/dL within 48 h or ≥ 1.5 times baseline) in patients with cirrhosis. A total of 98 patients [mean age 54 yr, Model for Endstage Liver Disease Sodium (MELD-Na) score 19, and baseline creatinine of 0.95 mg/dL] were included, of which 13% ( n = 13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared with patients who did not (9.30 vs. 13.35 ng/mL, P = 0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score as covariates on multivariable logistic regression, uromodulin was independently associated with AKI [odd ratios of 1.19 (95% confidence interval 1.02, 1.37; P = 0.02)]. Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis. Further studies are needed to better understand the role of uromodulin in the pathogenesis and as a predictive biomarker of AKI in this population. NEW & NOTEWORTHY In this study, we found that admission plasma uromodulin levels are significantly lower in patients who developed subsequent acute kidney injury (AKI) during their hospital stay compared with patients who did not. Additionally, uromodulin is independently associated with AKI development after adjusting for clinically relevant parameters such as age, sex, diabetes, hypertension, severity of cirrhosis, and kidney function. To our knowledge, this is the first study linking plasma uromodulin with AKI development in patients with cirrhosis.

scholarly journals Acute Kidney Injury among Hospitalized Children in China

2018 ◽  
Vol 13 (12) ◽  
pp. 1791-1800 ◽  
Author(s):  
Xin Xu ◽  
Sheng Nie ◽  
Aihua Zhang ◽  
Jianhua Mao ◽  
Hai-Peng Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Injury ◽  
Hospital Death ◽  
Hospitalized Children ◽  
Clinical Procedures ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Level Data ◽  
Nephrotoxic Drugs ◽  
Hospital Acquired

Background and objectivesHigh-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China.Design, setting, participants, & measurementsWe performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children’s hospitals in China during 2013–2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures.ResultsA total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates.ConclusionsPediatric AKI is common and is substantially underdiagnosed in China.

scholarly journals A Structured Workshop to Improve the Quality of Resident Discharge Summaries

2012 ◽  
Vol 4 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Jaideep S. Talwalkar ◽  
Jason R. Ouellette ◽  
Shawnette Alston ◽  
Gregory K. Buller ◽  
Daniel Cottrell ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Discharge Summary ◽  
Faculty Members ◽  
Evaluation Tool ◽  
Outpatient Physician ◽  
Hospital Discharge Summary ◽  
Structured Program ◽  
Discharge Summaries

Abstract Background Poor communication at hospital discharge can increase the risk of adverse events. The hospital discharge summary is the most common tool for detailing events related to hospitalization in preparation for postdischarge follow-up, yet deficiencies in discharge summaries have been widely reported. Resident physicians are expected to dictate discharge summaries but receive little formal training in this arena. We hypothesized that implementation of an educational program on chart documentation skills would result in improvements in the quality of hospital discharge summaries in a community hospital internal medicine residency program. Methods A monthly, 1-hour workshop was launched in August 2007 to provide consistent and ongoing instruction on chart documentation. Guided by a faculty moderator, residents reviewed 2 randomly selected peer chart notes per session using instruments developed for that purpose. After the workshop had been in place for 2 years, 4 faculty members reviewed 63 randomly selected discharge summaries from spring 2007, spring 2008, and spring 2009 using a 14-item evaluation tool. Results Mean scores for 10 of the 14 individual items improved in a stepwise manner during the 3 years of the study. Items related to overall quality of the discharge summary showed statistically significant improvement, as did the portion of the summaries “carbon copied” to the responsible outpatient physician. Conclusions The quality of hospital discharge summaries improved following the implementation of a novel, structured program to teach chart documentation skills. Ongoing improvement was seen 1 and 2 years into the program, suggesting that continuing instruction in those skills was beneficial.

Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management

2017 ◽  
Vol 35 (01) ◽  
pp. 001-009 ◽  
Author(s):  
J. Charlton ◽  
R. Guillet ◽  
K. Gist ◽  
M. Hanna ◽  
A. El Samra ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Neonatal Intensive Care ◽  
Current Knowledge ◽  
Kidney Injury ◽  
The United States ◽  
Clinical Scenarios ◽  
Practice Variations ◽  
Stage 1

Background Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI. Methods A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices. Results Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up. Conclusion Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.

Acute kidney injury after transcatheter aortic valve replacement: predictors and prognostic impact from a single, high-volume centre

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V De Marzo ◽  
G Crimi ◽  
V Gil Ad ◽  
S Benenati ◽  
F Pescetelli ◽  
...  
Keyword(s):  
Transcatheter Aortic Valve Replacement ◽  
Kidney Injury ◽  
Bleeding Complications ◽  
Adjusted Risk ◽  
Transcatheter Aortic Valve ◽  
Contrast Volume ◽  
All Cause Mortality ◽  
Baseline Creatinine ◽  
Age And Sex

Abstract Background Acute kidney injury (AKI) represents a common complication of transcatheter aortic valve replacement (TAVR), occurring in a variable proportion (from 10% to 30%) and being associated with an increased length of hospital stay and a 2- to 6-fold higher risk of mortality. Purpose We sought to identify pre-procedural and procedural variables independently associated with AKI and to analyze AKI impact on 1-month and 1-year all-cause mortality. Methods We prospectively collected consecutive patients undergoing TAVR at our centre. AKI was defined according to the Valve Academic Research Consortium (VARC)-2 criteria, as an increase of at least 0.3 mg/dL in serum creatinine or a urine output worsening (&lt;0.5 mL/kg for &lt;12 hours) occurring within 7 days after the procedure. Results From 664 consecutive TAVR conducted between January 2010 and December 2018 we excluded 19 (2.9%) patients for unsuccessful procedure according to VARC-2 criteria leading to a population of 645 patients. The mean follow-up was 9.6±4.3 months, age was 83.2±5.3, 270 (41.9%) were men. AKI complicated TAVR procedure in 141 (21.9%) patients. All-cause mortality occurred in 14 (2.2%) at 1-month and 51 (7.9%) patients at 1-year. AKI was more likely to complicate TAVR in patients who died within 1-month (4.7% vs. 0.8%, p=0.003) and 1-year (14.1% vs. 5.3%, p&lt;0.001) follow-up period. Multivariable regression analysis showed that baseline creatinine (OR: 1.46, 95% CI: 1.20–1.78, p&lt;0.001) and VARC-2 bleeding complications (OR: 1.49, 95% CI: 1.04–2.12, p=0.029) were independently associated with AKI incidence, while non-significant covariates were: age, gender, contrast volume, use of self-expandable valve and peri-procedural rapid pacing. Multivariable analysis adjusted for age and sex showed that AKI (HR: 3.02, 95% CI: 1.03–8.90, p=0.045) and chronic obstructive pulmonary disease (COPD) (HR: 4.12, 95% CI: 1.37–12.40, p=0.012) were independently associated with 1-month all-cause mortality. After 1 month, landmark analysis adjusted for age and sex showed that AKI (HR: 2.41, 95% CI: 1.17–4.96, p=0.017) and peri-procedural myocardial injury (HR: 2.36, 95% CI: 1.05–5.31, p=0.037) were independent predictors of 1-year all-cause mortality, while COPD, non-transfemoral route, and bleeding complications were not independently associated. Conclusions In a contemporary cohort of consecutive patients undergoing TAVR, AKI complicated ∼1 out of 5 procedures and is linked with about 4-fold adjusted risk of short-term death at 1-month and about 2-fold adjusted risk of subsequent death events up to 1-year follow-up. Baseline creatinine and bleeding complications, but not contrast volume were independently associated with AKI incidence. Landmark analysis for 1-year mortality Funding Acknowledgement Type of funding source: None

Language Barriers and Access to Care

2004 ◽  
Vol 22 (1) ◽  
pp. 59-73 ◽  
Author(s):  
SEONAE YEO
Keyword(s):  
Cultural Competency ◽  
Communication Skills ◽  
English Language ◽  
Language Barriers ◽  
The United States ◽  
Clinic Visit ◽  
Visit Time ◽  
Emergency Room Visits ◽  
Published Research

The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases (MEDLINE and CINAHL). Searches were limited to English-language-published research in the years from 1985 to 2003. A total of 47 published articles were included in this review. Overall these studies indicate that language barriers are associated with longer visit time per clinic visit, less frequent clinic visits, less understanding of physician’s explanation, more lab tests, more emergency room visits, less follow-up, and less satisfaction with health services. The results also indicate that people who are older, poorer, and female tend to have severe language barriers compared to those who are younger, wealthier, and male. Improvement of communication between patients and providers in relation to health disparity consists of cultural competency and communication skills. Implications of these studies for practice and further research are outlined.

scholarly journals Saskatchewan Movement Disorders Program

2015 ◽  
Vol 42 (2) ◽  
pp. 74-87 ◽  
Author(s):  
Ali H. Rajput ◽  
Alex Rajput
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Patient Care ◽  
Movement Disorder ◽  
Movement Disorders ◽  
The United States ◽  
Clinic Visit ◽  
Formalin Fixed

AbstractWe review the Saskatchewan Movement Disorders Program, which started in 1968 and has had the dual goals of patient care and research. The clinics are structured to collect research-worthy data including videos, longitudinal follow-up, and autopsy studies of patients seen in the clinics. At every clinic visit, the patient is evaluated by one or both authors. A total of 25% to 30% of the deceased come to autopsy. Frozen half-brain and formalin-fixed remnants from autopsy are preserved in our laboratories. Patients not seen in our clinic are not included in research, which makes it different from brain banks. So far, 515 cases have come to autopsy. So far, there have been 17 collaborating scientific teams from Canada, the United States, Europe, and Japan. The collaborators are not charged for access to our resources. This program offers a unique opportunity to study multiple aspects of movement disorder patients seen in clinical practice.

scholarly journals CIRRHOTIC PATIENTS WITH ACUTE KIDNEY INJURY (AKI) HAVE HIGHER MORTALITY AFTER ABDOMINAL HERNIA SURGERY

2021 ◽  
Vol 34 (3) ◽  
Author(s):  
Liliana DUCATTI ◽  
Luciana B. P. HADDAD ◽  
Alberto MEYER ◽  
Lucas S. NACIF ◽  
Rubens M. ARANTES ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Emergency Surgery ◽  
Kidney Injury ◽  
Abdominal Hernia ◽  
Hernia Surgery ◽  
Baseline Creatinine ◽  
Cirrhotic Patients ◽  
Postoperative Aki

ABSTRACT Background: The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). Aim: To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. Methods: Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite´s club. They were divided into two groups: with (AKI PO) and without AKI . Results: All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. Conclusions: There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.

Under-Recognition of Neonatal Acute Kidney Injury and Lack of Follow-Up

2020 ◽  
Author(s):  
Jean-Philippe Roy ◽  
Stuart L. Goldstein ◽  
Meredith P. Schuh
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Blood Pressure Measurement ◽  
Kidney Injury ◽  
Discharge Summary ◽  
High Risk Population ◽  
Design Data

Objective Acute kidney injury (AKI) incidence is 30% in neonatal intensive care units (NICU). AKI is associated with increased mortality and risk of chronic kidney disease (CKD) in children. To assess follow-up and early CKD, we retrospectively reviewed outcomes of Cincinnati Children's Hospital Medical Center (CCHMC) cohort of neonates from the AWAKEN trial (2014). Study Design Data from 81 CCHMC patients were extracted from the AWAKEN dataset. KDIGO (Kidney Disease: Improving Global Outcomes) criteria for serum creatinine (SCr) and urine output (UOP) <1 mL/kg/h, reported per 24 hours on postnatal days 2 to 7, were used to define AKI. Charts were reviewed until May 2019 for death, nephrology consult, AKI diagnosis on discharge summary, follow-up, and early CKD at >6 months of age (defined as: estimated glomerular filtration rate < 90 mL/min/1.73 m2, hyperfiltration, proteinuria, hypertension, or abnormal ultrasound). Patients were considered to have renal follow-up if they had ≥1 follow-up visit containing: SCr, urinalysis, or blood pressure measurement. Results Seventy-seven patients had sufficient data to ascertain AKI diagnosis. In total 47 of 77 (61%) were AKI+ by SCr or UOP criteria (20 stage 1, 14 stage 2, 13 stage 3). Four died during their admission and five were removed from CKD analyses due to urologic anomalies. AKI-UOP alone outnumbered AKI-SCr (45 AKI+ vs 5 AKI+ for all stages). 33% of patients had <2 SCr measured while inpatient. Only 3 of 47 AKI+ patients had a nephrology consult (all stage 3 by SCr) and 2 of 47 had AKI included in discharge summary. 67% of AKI+ patients had follow-up. In total 10 of 43 (23%) AKI+ versus 12 of 25 (48%) AKI− patients had ≥1 marker of early CKD assessed after 6 months. Based on SCr, 3 of 7 (43%) AKI+ had hyperfiltration versus 0 of 7 (0%) AKI− (p = 0.19). Conclusion AKI is vastly under-recognized in the NICU, especially if based on SCr alone. This leads to insufficient follow-up to ascertain renal sequelae in this high-risk population. Key Points

scholarly journals Natural History and Evolution of Anti-Interferon-γ Autoantibody-Associated Immunodeficiency Syndrome in Thailand and the United States

2019 ◽  
Vol 71 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Gloria H Hong ◽  
Ana M Ortega-Villa ◽  
Sally Hunsberger ◽  
Ploenchan Chetchotisakd ◽  
Siriluck Anunnatsiri ◽  
...  
Keyword(s):  
United States ◽  
Natural History ◽  
The United States ◽  
Interferon Γ ◽  
Mycobacterium Abscessus ◽  
Annual Data ◽  
Persistent Infections ◽  
Ifn Γ ◽  
Immunodeficiency Syndrome

Abstract Background The natural history of anti-interferon-γ (IFN-γ) autoantibody-associated immunodeficiency syndrome is not well understood. Methods Data of 74 patients with anti-IFN-γ autoantibodies at Srinagarind Hospital, Thailand, were collected annually (median follow-up duration, 7.5 years). Annual data for 19 patients and initial data for 4 patients with anti-IFN-γ autoantibodies at the US National Institutes of Health were collected (median follow-up duration, 4.5 years). Anti-IFN-γ autoantibody levels were measured in plasma samples. Results Ninety-one percent of US patients were of Southeast Asian descent; there was a stronger female predominance (91%) in US than Thai (64%) patients. Mycobacterium abscessus (34%) and Mycobacterium avium complex (83%) were the most common nontuberculous mycobacteria in Thailand and the United States, respectively. Skin infections were more common in Thailand (P = .001), whereas bone (P &lt; .0001), lung (P = .002), and central nervous system (P = .03) infections were more common in the United States. Twenty-four percent of Thai patients died, most from infections. None of the 19 US patients with follow-up data died. Anti-IFN-γ autoantibody levels decreased over time in Thailand (P &lt; .001) and the United States (P = .017), with either cyclophosphamide (P = .01) or rituximab therapy (P = .001). Conclusions Patients with anti-IFN-γ autoantibodies in Thailand and the United States had distinct demographic and clinical features. While titers generally decreased with time, anti-IFN-γ autoantibody disease had a chronic clinical course with persistent infections and death. Close long-term surveillance for new infections is recommended.

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