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Outcomes in acute kidney injury in noncritically ill patients lately referred to nephrologist in a developing country: a comparison of AKIN and KDIGO criteria.

ABSTRACT: BACKGROUND:In low-middle-income countries (LMICs), data regarding acute kidney injury (AKI) are scarce. AKI patients experience delayed diagnosis. This study aimed to evaluate whether delayed nephrologist consultation (NC) affected outcomes of AKI patients and compare Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO). METHODS:An observational, retrospective study was conducted in a tertiary public hospital in an LMIC. RESULTS:Overall, 103 AKI patients were analysed. In-hospital mortality was 61.16%, and dialysis was required in 38.83%. NC took place after 48?h in 68.93% of the patients. Mean time for NC was 5.22?±?4.30?days. At NC, serum creatinine was 4.48 (±3.40) mg/dL and blood urea nitrogen was 68.21 (± 35.02) mg/dL. The AKIN and KDIGO stage stratifications were identical; KDIGO stage 3 was seen in 58.25% of the patients. The group with NC?>? 4?days had a mortality rate of 74.46% and the group with NC???4?days had a mortality rate of 50% (p?=?0.011). Multivariate analysis showed that haemodialysis was independently associated with mortality. NC?>? 4?days was associated with death [odds ratio 2.66 (95% confidence interval, 1.36-4.35), p?=?0.001]. Logistic regression showed an OR of 1.20 (95% CI, 1.05-1.37) (p?=?0.008) for each day of delayed NC. CONCLUSION:Delayed NC was associated with mortality even after adjustments, as was haemodialysis, though marginally. In AKI patients with NC?>?4?days, there was a high prevalence of KDIGO stage 3, and AKIN and KDIGO criteria were identical.

SUBMITTER: Nascimento GVRD

PROVIDER: S-EPMC7066785 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Outcomes in acute kidney injury in noncritically ill patients lately referred to nephrologist in a developing country: a comparison of AKIN and KDIGO criteria.

Nascimento Ginivaldo Victor Ribeiro do GVRD Silva Marcela do Nascimento MDN Carvalho Neto Juarez Duarte de JD Feitosa Filho Ludgero Ribeiro LR Antão Jessica Duarte JD

BMC nephrology 20200311 1

<h4>Background</h4>In low-middle-income countries (LMICs), data regarding acute kidney injury (AKI) are scarce. AKI patients experience delayed diagnosis. This study aimed to evaluate whether delayed nephrologist consultation (NC) affected outcomes of AKI patients and compare Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO).<h4>Methods</h4>An observational, retrospective study was conducted in a tertiary public hospital in an LMIC.<h4>Results</h4>Overall, ...[more]

PMID: 32160876

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Project description:BackgroundComparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU).MethodsWe conducted a single-center, pragmatic, multiple-crossover trial comparing balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) with saline among adults who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU. The type of crystalloid that was administered in the emergency department was assigned to each patient on the basis of calendar month, with the entire emergency department crossing over between balanced crystalloids and saline monthly during the 16-month trial. The primary outcome was hospital-free days (days alive after discharge before day 28). Secondary outcomes included major adverse kidney events within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first.ResultsA total of 13,347 patients were enrolled, with a median crystalloid volume administered in the emergency department of 1079 ml and 88.3% of the patients exclusively receiving the assigned crystalloid. The number of hospital-free days did not differ between the balanced-crystalloids and saline groups (median, 25 days in each group; adjusted odds ratio with balanced crystalloids, 0.98; 95% confidence interval [CI], 0.92 to 1.04; P=0.41). Balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days than saline (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P=0.01).ConclusionsAmong noncritically ill adults treated with intravenous fluids in the emergency department, there was no difference in hospital-free days between treatment with balanced crystalloids and treatment with saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SALT-ED ClinicalTrials.gov number, NCT02614040 .).

Project description:Acute kidney injury (AKI) has been characterized in high-risk pediatric hospital inpatients, in whom AKI is frequent and associated with increased mortality, morbidity, and length of stay. The incidence of AKI among patients not requiring intensive care is unknown.Retrospective cohort study.13,914 noncritical admissions during 2011 and 2012 at our tertiary referral pediatric hospital were evaluated. Patients younger than 28 days or older than 21 years of age or with chronic kidney disease (CKD) were excluded. Admissions with 2 or more serum creatinine measurements were evaluated.Demographic features, laboratory measurements, medication exposures, and length of stay.AKI defined as increased serum creatinine level in accordance with KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Based on time of admission, time interval requirements were met in 97% of cases, but KDIGO time window criteria were not strictly enforced to allow implementation using clinically obtained data.2 or more creatinine measurements (one baseline before or during admission and a second during admission) in 2,374 of 13,914 (17%) patients allowed for AKI evaluation. A serum creatinine difference ?0.3mg/dL or ?1.5 times baseline was seen in 722 of 2,374 (30%) patients. A minimum of 5% of all noncritical inpatients without CKD in pediatric wards have an episode of AKI during routine hospital admission.Urine output, glomerular filtration rate, and time interval criteria for AKI were not applied secondary to study design and available data. The evaluated cohort was restricted to patients with 2 or more clinically obtained serum creatinine measurements, and baseline creatinine level may have been measured after the AKI episode.AKI occurs in at least 5% of all noncritically ill hospitalized children, adolescents, and young adults without known CKD. Physicians should increase their awareness of AKI and improve surveillance strategies with serum creatinine measurements in this population so that exacerbating factors such as nephrotoxic medication exposures may be modified as indicated.

Dataset Information

Outcomes in acute kidney injury in noncritically ill patients lately referred to nephrologist in a developing country: a comparison of AKIN and KDIGO criteria.

Publications

Outcomes in acute kidney injury in noncritically ill patients lately referred to nephrologist in a developing country: a comparison of AKIN and KDIGO criteria.

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