Clinical Acute Kidney Injury 2 (original) (raw)
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2020
Acute kidney injury is a syndrome characterised by the rapid loss of the kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. Dialysis modalities used in AKI (Acute Kidney Injury) are HD (Hemodialysis), CRRT (Continuous renal replacement therapy) acute PD and CAPD either manually or with automated machine in advanced centers. Peritoneal dialysis, initially used as first modality of renal replacement therapy in AKI patients before HD is widely available. Usage of PD in developing countries is advantageous due to its lower cost and minimal infrastructural requirements. This is a Retrospective cross sectional study indicating an importance of High Volume Peritoneal Dialysis (HVPD) in ICU patients who had AKI according to AKIN/KDIGO definition, with good outcome, which can be used as a modality of RRT in resource poor countries. Keywords: HVPD, AKI, AKIN.
CLINICAL ACUTE KIDNEY INJURY 1
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: Acute kidney injury (AKI) is an important public health problem. AKI is a risk factor for progression of kidney disease, incidence of chronic kidney disease (CKD) and mortality. The aim of the study was to assess characteristics, renal survival and mortality of patients who developed AKI stage 3, according to KDIGO guidelines, and needed renal replacement therapy (RRT), not in intensive care unit. Methods: All patients who required RRT due to AKI stage 3 along two years were included, excluding patients in intensive care unit. Demographic and personal history data, previous renal function, cause of AKI, renal function, renal survival, and mortality at one, three, six and twelve months after AKI were recorded. Results: A total of 107 patients were enrolled (incidence 134 patients/106 population/ year). Mean age 72.2±13.9 (range 25-92), 57.9% men. Patient's characteristics: 77.6% were hypertensive, 40.2% were diabetics, 45.8% were dyslipemics, 41.1% were obese, 27.1% were smokers, and 61.2% with chronic renal failure (eFG<60mil/min) of which 54% stage 3, 36.5% stage 4, and 9.5% stage 5. Cause of AKI: renal disease 63.6%, prerrenal 28.9% and obstructive causes 7.5%.Renal function: Serum creatinine before AKI 1.78±1.12 mg/dL; maximum serum creatinine during AKI hospitalization 7.39 ±4.43mg/dL; at discharge, 2.64±1.62mg/dL; one month later, 2.07±1.36mg/dL; three months later, 2.35±1.60mg/dL; six months later, 2.25±1.85mg/dL and one year later, 1.95±1.14 mg/dL.During hospitalization, 24.3% died, 16.8% kept on RRT at discharge, and 58.9% recovered partial or completely renal function. One month after AKI, 31.7% had died, 15.8% kept on RRT, and 52.5% preserved renal function, 5.6% was missing. Three months later, 45.7% died, 10.9% kept on RRT, and 43.5% preserved renal function, 14% was missing. Six months later, 48.3% had die, 10% kept on RRT, and 33.3% preserved renal function, 8.3% were missing. Finally, one year after AKI, 71.8% of patients had died, 9.9% needed RRT, 18.3% recovered partial or completely renal function and 33.6% missing. AKI in diabetic or dyslipemic patients has an increased mortality ( p=0.03 and p=0.06 respectively). CKD before AKI is not associated with increased mortality.Renal function according to KDOQI classification of patients who had AKI stage 3 was: at discharge: stage 1 1.6%, 2 16.1%, 3 24.2%, 4 37.1% and 5 21.0%; three months after AKI : stage 1 2.5%, 2 15%, 3 30%, 4 32.5% and 5 17.5%; six months after AKI: 1 6.5%, 2 12.9%, 3 38.7%, 4 19.4% and 5 19.4% and one year after AKI, renal function was: 2 25%, 3 41.7%, 4 25% and 5 8.3%. Conclusions: In our health area AKI stage 3 requiring RRT have a incidence similar to other studies. Mortality in AKI patients exceeds 70% one year after AKI episode and renal survival decreases in this period. Nephrology follow-up must be established in patients who survive AKI. The develop of tools to identify high-risk patients and to promote renal recovery is important to reduce burden of CKD and mortality.
International Urology and Nephrology, 2012
Background Acute kidney injury (AKI) requiring dialysis in critically ill patients is associated with an inhospital mortality rate of 50-80 %. Extended daily hemodialysis (EHD) and high volume peritoneal dialysis (HVPD) have emerged as alternative modalities. Methods A double-center, randomized, controlled trial was conducted comparing EHD versus HVPD for the treatment for AKI in the intensive care unit (ICU). Four hundred and seven patients were randomized and 143 patients were analyzed. Principal outcome measure was hospital mortality, and secondary end points were recovery of renal function and metabolic and fluid control. Results There was no difference between the two groups in relation to median ICU stay [11 (5.7-20) vs. 9 (5.7-19)], recovery of kidney function (26.9 vs. 29.6 %, p = 0.11), need for chronic dialysis (9.7 vs. 6.5 %, p = 0.23), and hospital mortality (63.4 vs. 63.9 %, p = 0.94). The groups were different in metabolic and fluid control. Blood urea nitrogen (BUN), creatinine, and bicarbonate levels were stabilized faster in EHD group than in HVPD group. Delivered Kt/V and ultrafiltration were higher in EHD group. Despite randomization, there were significant differences between the groups in some covariates, including age, pre-dialysis BUN, and creatinine levels, biased in favor of the EHD. Using logistic regression to adjust for the imbalances in group assignment, the odds of death associated with HVPD was 1.4 (95 % CI 0.7-2.4, p = 0.19). A detailed investigation of the randomization process failed to explain the marked differences in patient assignment. Conclusions Despite faster metabolic control and higher dialysis dose and ultrafiltration with EHD, this study provides no evidence of a survival benefit of EHD compared with HVPD. The limitations of this study were that the results were not presented according to the intention to treat and it did not control other supportive management strategies as nutrition support and timing of dialysis initiation that might influence outcomes in AKI.
Kidney International, 2008
There is no consensus in the literature on the best renal replacement therapy (RRT) in acute kidney injury (AKI), with both hemodialysis (HD) and peritoneal dialysis (PD) being used as AKI therapy. However, there are concerns about the inadequacy of PD as well as about the intermittency of HD complicated by hemodynamic instability. Recently, continuous replacement renal therapy (CRRT) have become the most commonly used dialysis method for AKI around the world. A prospective randomized controlled trial was performed to compare the effect of high volume peritoneal dialysis (HVPD) with daily hemodialysis (DHD) on AKI patient survival. A total of 120 patients with acute tubular necrosis (ATN) were assigned to HVPD or DHD in a tertiary-care university hospital. The primary end points were hospital survival rate and renal function recovery, with metabolic control as the secondary end point. Sixty patients were treated with HVPD and 60 with DHD. The HVPD and DHD groups were similar for age (64.2719.8 and 62.5721.2 years), gender (male: 72 and 66%), sepsis (42 and 47%), hemodynamic instability (61 and 63%), severity of AKI (Acute Tubular Necrosis-Index Specific Score (ATN-ISS): 0.6870.2 and 0.6670.2), Acute Physiology, Age, and Chronic Health Evaluation Score (APACHE II) (26.978.9 and 24.178.2), pre-dialysis BUN (116.4733.6 and 112.6736.8 mg per 100 ml), and creatinine (5.871.9 and 5.971.4 mg per 100 ml). Weekly delivered Kt/V was 3.670.6 in HVPD and 4.770.6 in DHD (Po0.01). Metabolic control, mortality rate (58 and 53%), and renal function recovery (28 and 26%) were similar in both groups, whereas HVPD was associated with a significantly shorter time to the recovery of renal function. In conclusion, HVPD and DHD can be considered as alternative forms of RRT in AKI.
BioMed research international, 2014
This trial aimed to compare the dialysis complications occurring during different durations of extended daily dialysis (EDD) sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline dose ranging from 0.3 to 0.7 μg/kg/min. Patients were divided into two groups randomly: in G1, 6 h sessions were performed and, in G2, 10 h sessions were performed. Seventy-five patients were treated with 195 EDD sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalaemia, and hypophosphataemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 and G2 were similar in male predominance and SOFA. There was no significant difference between the two groups in hypotension, filter clotting, hypokalaemia, and hypophosphataemia. However, the group treated with sessions of 10 hours showed higher refractory to clinical measures for hypotension and dialysis sessions ...
Medical Journal of Shree Birendra Hospital
Introduction: Acute kidney injury (AKI) is the abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. Most patients with AKI recover renal function conservatively yet few require renal support with intermittent Hemodialysis (HD). We conducted a study in a tertiary level hospital to find out the etiology and outcome of the patients presenting with AKI who required dialysis. Methods: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital from Jan 2015 to Dec 2016, i.e. over a period of two years. Consent was taken from both the institution as well as the patients for the evaluation of data. Patients were followed up for at least three months from the time of enrolment. Data were tabulated and analysed using SPSS software. Results: Total 50 patients were included in the study, out of which 67% were male. The mean age of the patients was 54.54 years (SD±18.6). Hypertension was present in 44% and Diabetes in 18% as comorbidities. The commonest etiologies were urinary tract infection (30 %), acute gastroenteritis (24%) and obstructive uropathy (18%). The mean creatinine level at the time of nephrology consultation, maximum level and at the time of discharge were 6.5 (SD ± 2.62), 7.3 (SD ± 2.13) and 2.2 (SD ± 1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD 54% cases. The mean number of intermittent HD used was 3.36. Out of total patients, 68% had complete recovery, 26% died and 6% had persistent renal dysfunction at the end of three months. Conclusions: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.