medigraphic.com

2014, Number 2

<< Back Next >>

Rev Med MD 2014; 5.6 (2)

Incidence of patients with acute kidney failure in non-selected hospital admissions and outcome according to nephrology consultation

Albarrán-López P, Chávez-Ińiguez J, García-García G

Language: Spanish
References: 28
Page: 97-103
PDF size: 179.81 Kb.


ABSTRACT

Introduction. Acute kidney injury (AKI) is a common and severe disease in hospitalized patients. It is frequently not detected and under estimated by the nephrology unit. This leads to an inadequate attention, torpid evolution and high morbi-mortality, since only patients with severe AKI are referenced.
Material y Methods. We organized a prospective cohort from electronic records of patients hospitalized in one day and followed their serum creatinine levels until hospital discharge or death. We dichotomized the presence or absence of AKI according to KDIGO. Patients less than 15 years old and those 2 admitted to obstetrics and nephrology were excluded. T-student and χ2 formulas were used to identify the differences, p=0.05 was considered significant.
Results. 402 patients were evaluated, 127 (32%) developed AKI. The majority included men (65%), old age (60-80 years old), diabetic (43%) and most commonly present in medical cases (56%). The most frequent etiologies in patients related to patients of greater age were sepsis 46(36.2%) and hypovolemia 38 (29.9%). According to the nephrology unit, only 11% of the cases were evaluated by nephrology, 100% of the cases were KDIGO 3 stage, and 43% mortality (6 patients). In general, those patients sent to nephrology were the eldest, had greater comorbidities, and presented with the most severe AKI cases. In spite of this, the serum creatinine levels in patients referenced to nephrology were the same as those who were not evaluated by this unit.
Discussion. AKI is very frequent in hospitalized patients, affecting 32% of non-selected admitted patients. Many times kidney injury resolves spontaneously and patients often lack attention by nephrology. Those patients evaluated by nephrology (11%) had greater comorbidities and it is possible that this association caused a greater mortality. A big percentage (30%) of these patients had a high serum creatinine when discharged and lack an outpatient follow-up by nephrology.


REFERENCES

  1. 1.Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med 2008, 36 (suppl 4): S146–S151.

  2. 2.Challiner R, Ritchie JP, Fullwood C, Loughnan P, Hutchison AJ. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust. BMC Nephrol. 2014 May 29;15:84.

  3. 3.Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, Jaber BL; Acute Kidney Injury Advisory Group of the American Society of Nephrology. World Incidence of AKI: A Meta- Analysis. Clin J Am Soc Nephrol. 2013 Sep;8(9):1482-93

  4. 4.Eckardt KU, Coresh J, DevuystO, Johnson RJ, Köttgen A, Levey AS, LevinA: Evolving importance of kidney disease: From subspecialty to global health burden. Lancet .2013; 382: 158–169.

  5. 5.Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol. 2013 Jan;24(1):37-42.

  6. 6.Cerdá J, Ronco C. Modalities of continuous renal re placement therapy: technical and clinical considerations. Semin Dial. 2009 Mar-Apr;22(2):114- 22.

  7. 7.Metcalfe W, Simpson M, Khan IH, et al. Acute renal failure requiring renal replacement therapy: incidence and outcome. QJM 2002;95:579-83

  8. 8.Uchino S, Kellum JA, Bellomo R. Acute renal failure in critically ill patients: a ultinational, multicenter study. JAMA; 2005;294:813-8.

  9. 9.Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units — causes, outcome, and prognostic factors of hospital mortality: a prospective, multicenter study. Crit Care Med 1996;24:192-8.

  10. 10.Mehta RL, Pascual MT, Soroko S. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 2004; 66:1613-21.

  11. 11.Morgan E. Grams, Hamid Rabb. The distant organ effects of acute kidney injury. Kidney International 2012; 81, 942–948.

  12. 12.Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney inter., Suppl. 2012; 2: 1–138.

  13. 13.Cartin-Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET. et al. Risk Factors for Development of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-Analysis of Observational Studies. Critical Care Research and Practice ,ID 691013, 15 pages.2012

  14. 14.Zoltán H. Endre and John W. Pickering ACUTE KIDNEY INJURY Late-onset acute kidney injury - subacute or more of the same? Rev. Nephrol. 2014; 10, 133–134.

  15. 15.Murugan R, Kellum JA. Acute kidney injury: what's the prognosis? Nat Rev Nephrol 2011; 7: 209–217.

  16. 16.Harel Z, Wald R, Bargman JM, Mamdani M, Etchells E, Garg AX, Ray JG, Luo J, Li P, Quinn RR, Forster A, Perl J, Bell CM. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int. 2013 May;83(5):901-8.

  17. 17.Liu KD, Matthay MA. Advances in critical care for the nephrologist: acute lung injury/ARDS. Clin J Am Soc Nephrol. 2008 Mar;3(2):578-86.

  18. 18.Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T: Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care. 2005;9(6):R700-9.

  19. 19.Lo LJ, Go AS, Chertow GM, McCulloch CE, Fan D, Ordońez JD, Hsu CY. Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease. Kidney Int. 2009 Oct;76(8):893-9.

  20. 20.Coca SG. Acute kidney injury in elderly persons. Am J Kidney Dis. 2010 Jul;56(1):122-31.

  21. 21.Coca SG, Yusuf B, Shlipak MG et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009; 53: 961–973

  22. 22.Lafrance JP, Miller DR. Acute kidney injury associates with increased long-term mortality. J Am Soc Nephrol 2010; 21: 345–352

  23. 23.Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, Ray JG; University of Toronto Acute Kidney Injury Research Group. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009 Sep 16;302(11):1179- 85.

  24. 24.Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, Collins AJ. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009 Jan;20(1):223-8.

  25. 25.Bucaloiu ID, Kirchner HL, Norfolk ER, Hartle JE 2nd, Perkins RM. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012 Mar;81(5):477-85.

  26. 26.Acute Kidney Injury. Health Service Journal (in association with NHS Kidney Care). 2001; 23(Suppl 6): S1–S9.

  27. 27.Porter CJ, Juurlink I, Bisset LH, Bavakunji R, Mehta RL, Devonald MA. A real-time electronic alert to improve detection of acute kidney injury in a large teaching hospital. Nephrol Dial Transplant. 2014 Oct;29(10):1888-93.

  28. 28.Kearns B, Gallagher H, de Lusignan S. Predicting the prevalence of chronic kidney disease in the English population: a cross-sectional study. BMC Nephrol 2013; 14: 49.




2020     |     www.medigraphic.com