Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference (original) (raw)
Related papers
Acute kidney injury: an increasing global concern
The Lancet
Despite an increasing incidence of acute kidney injury in both high-income and low-income countries and growing insight into the causes and mechanisms of disease, few preventive and therapeutic options exist. Even small acute changes in kidney function can result in short-term and long-term complications, including chronic kidney disease, end-stage renal disease, and death. Presence of more than one comorbidity results in high severity of illness scores in all medical settings. Development or progression of chronic kidney disease after one or more episode of acute kidney injury could have striking socioeconomic and public health outcomes for all countries. Concerted international action encompassing many medical disciplines is needed to aid early recognition and management of acute kidney injury.
#6039 Epidemiology and Outcomes of Acute Kidney Injury: Don't Forget the Children
Nephrology Dialysis Transplantation
Background and Aims Acute kidney disease (AKI) has evolved from a primary single renal disease to a syndrome secondary to other systemic illness. The aim of this study is to asses AKI epidemiology in a large East European country database comprising a mixt paediatric population (critically ill and non-critically ill) and the impact on mortality and hospitalization length. Method We conducted a retrospective observational study on all the admitted paediatric patients from 1 day to 18 years old between first of January 2014 until 31 December 2021. Out of 137760 admissions, 2194 patients were included in the study. We classified the different age groups as: premature (all the babies born before 37 weeks of gestation), full-term new-borns, infants (between 28 days and 12 months of life), toddlers (over 12 months up to 3 years), pre-schoolers (between 3 and 5 years), scholars (6 years to 11 years) and adolescents (12 to 18 years). Results The overall incidence of AKI was 15.92/1000 hospi...
Background Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional diff erences in acute kidney injury recognition, management, and outcomes. Methods In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confi rmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classifi ed countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person. Findings Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p=0.33; p<0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549). Interpretation We identifi ed common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community healthcare settings, especially in LICs.
Acute Kidney Injury Epidemiology in pediatrics
Brazilian Journal of Nephrology
We performed a search in the MEDLINE database using the MeSH term: "Acute Kidney Injury", selecting the subtopic "Epidemiology", and applying age and year of publication filters. We also searched for the terms: "acute renal failure" and "epidemiology" "acute tubular necrosis" and "epidemiology" in the title and summary fields with the same filters. In a second search, we searched in the LILACS database, with the terms: "acute renal injury", or "acute renal failure" or "acute kidney injury" and the age filter. All abstracts were evaluated by the authors and the articles considered most relevant, were examined in their entirety. Acute Kidney Injury (AKI) -related mortality ranged from 3-63% in the studies included in this review. AKI etiology has marked regional differences, with sepsis being the main cause in developed countries. In developing countries, primary renal diseases and hypovolemia ar...
The definition of acute kidney injury and its use in practice
Kidney international, 2015
Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. RIFLE was modified for pediatric use (pRIFLE). They were developed using both evidence and consensus. Small rises in serum creatinine are independently associated with increased mortality, and hence are incorporated into the current definition of AKI. The recent definition from the international KDIGO guideline merged RIFLE and AKIN. Systematic review has found that these definitions do not differ significantly in their performance. Health-care staff caring for children or adults should use standard criteria for AKI, such as the pRIFLE or KDIGO definitions, respect...
Outcome of pediatric acute kidney injury: a multicenter prospective cohort study
Pediatric Nephrology, 2017
Background Acute kidney injury (AKI) is a common problem encountered in critically ill children with an increasing incidence and evolving epidemiology. AKI carries a serious morbidity and mortality in patients requiring admission to a pediatric intensive care unit (PICU). Methods We undertook a prospective cohort study of PICU admissions at three tertiary care hospitals in the Kingdom of Saudi Arabia over 2 years. The Kidney Disease Improving Global Outcomes (KDIGO) definition was used to diagnose AKI. Results A total of 1367 pediatrics PICU admissions were included in the study. AKI affected 511 children (37.4%), with 243 children (17.8%) classified as stage I (mild), 168 patients (12.3%) stage II (moderate), and 100 children (7.3%) were classified as stage III (severe). After adjustment for age, sex, and underlying diagnosis, in-hospital mortality was six times more likely among patients with AKI as compared to patients with normal renal function (adjusted OR: 6.5, 95% CI: 4.2-10). AKI was also a risk factor for hypertension (adjusted OR: 4.1, 95% CI: 2.8-5.9) and prolonged stay in the PICU and hospital, as it increased the average number of admission days by 10 (95% CI: 8.6-11) days in the PICU and 12 (95% CI: 10-14) days in the hospital. Conclusions One-third of PICU admissions were complicated with AKI. AKI was associated with increased hospital mortality and the length of stay in both PICU and hospital.
Bangladesh Critical Care Journal, 2019
Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a treatablecondition. Any disease when associated with AKI, mortality and morbidity increase manifolds.1 Early diagnosis andtreatment is important to reduce morbidity, mortality and ICU admission. Causes of AKI may vary in country to countryeven within the country. International society of Nephrology has set a high ambitious goal “0 by 25” targeting zerodeath due to untreated AKI by 2025. Heading this challenge, it is important to know the causes of AKI worldwide.However, most of the AKI studies have been done in the developed countries and limited information is availableregarding Asia, Africa and south America. Inspired by this slogan, this study was directed to find out the causes of AKIin admitted patients in United Hospital Limited between July 2015 to February 2017. Total 98 patients were includedin the study. In our study, Infection and cardio-renal syndrome were the leading causes...
Acute kidney injury in children: incidence, awareness and outcome – a retrospective cohort study
Background The primary objective was to determine the epidemiologic influence of AKI awareness among physicians in a mixt paediatric population, including neonates. Methods This single-centre, multiyear, observational retrospective study included all admitted patients between first of January 2014 until 31 December 2021. AKI was identified in 2194 patients out of the 128 036 hospital admissions with 129 936 serum creatinine measurements. Matching comparisons were used between AKI aware and AKI non-aware patients. Results The overall incidence of AKI was 1.65%. Stage 1 was identified in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. The most prevalent cause of AKI was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Exposure to sepsis, critical illness, hypovolemic shock and mechanical ventilation increased mortality by 2.09, 4.69, 4.64- and 4.93-times (p = 0.001). Cancer and heart failure incr...
Acute Kidney Injury: Epidemiology, Diagnosis, Prognosis, and Future Directions
European medical journal, 2015
Acute kidney injury (AKI) is a common problem highly associated with hospitalisation. AKI is the cause of harmful short-term consequences: longer hospital stays, greater disability after discharge, and greater risk of in-hospital mortality, as well as adverse long-term outcomes, such as progression to chronic kidney disease, development of cardiovascular disease, and increased risk of long-term mortality. The concept of AKI has changed since the introduction of the 'Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease' (RIFLE) classification. More recently, the 'Kidney Disease Improving Global Outcomes' (KDIGO) classification appears to have provided increased diagnostic sensitivity and outcome-prediction capability. Novel biomarkers and further research on the role of the immune system in AKI may help improve the diagnosis, severity, outcome evaluation, and treatment of the condition. In this review we describe the epidemiology, diagnosis, and prognosis of AKI, as well as possible future directions for its clinical management.