Differences in community, hospital and intensive care unit-acquired acute kidney injury: observational study in a nephrology service of a developing country

Daher, Elizabeth De Francesco; Silva, Geraldo Bezerra da; Santos, Silvia; Bezerra, Carla Camila R.; Diniz, Elton; Lima, Rafael Siqueira Athayde; Babosa, Célio A.; Guimarães, Antônio Augusto; Mota, Rosa Maria Salani; Abreu, Krasnalhia Lívia S.; Libório, Alexandre Braga

doi:10.5414/cn107167

Cited by 35 publications

(29 citation statements)

References 25 publications

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“…All of these were performed in patients with CA-AKI admitted to the hospital. Two of these studies, based in Brazil and China, had less than a third of the patient numbers presented here (27,28). The causes of AKI, as well as the prevalence of various comorbid conditions in these studies, probably differ from those present in our (22,23).…”

Section: Discussionmentioning

confidence: 90%

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

258

245

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Background and objective Compared with AKI in hospitalized patients, little is known about patients sustaining AKI in the community and how this differs from AKI in hospital. This study compared epidemiology, risk factors, and short-and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) AKI.Design, setting, participants, & measurements A total of 15,976 patients admitted to two district general hospitals between July 11, 2011, and January 15, 2012 were studied. Through use of an electronic database and the AKI Network classification, 686 patients with CA-AKI and 334 patients with HA-AKI were identified. Patients were followed up for 14 months, and data were collated on short-term and long-term renal and patient outcomes.Results The incidence of CA-AKI among all hospital admissions was 4.3% compared with an incidence of 2.1% of HA-AKI, giving an overall AKI incidence of 6.4%. Patients with CA-AKI were younger than patients with HA-AKI. Risks for developing HA and CA-AKI were similar and included preexisting CKD, cardiac failure, ischemic heart disease, hypertension, diabetes, dementia, and cancer. Patients with CA-AKI were more likely to have stage 3 AKI and had shorter lengths of hospital stay than patients with HA-AKI. Those with CA-AKI had better (multivariate-adjusted) survival than patients with HA-AKI (hazard ratio, 1.8 [95% CI, 1.44-2.13; P,0.001] for HA-AKI group). Mortality for the CA-AKI group was 45%; 43.7% of these deaths were acute inhospital deaths. Mortality for the HA-AKI group was 62.9%, with 68.1% of these deaths being acute in-hospital deaths. Renal referral rates were low across the cohorts (8.3%). Renal outcomes were similar in both CA-AKI and HA-AKI groups, with 39.4% and 33.6% of patients in both groups developing de novo CKD or progression of preexisting CKD within 14 months, respectively. ConclusionPatients with CA-AKI sustain more severe AKI than patients with HA-AKI. Despite having risk factors similar to those of patients with HA-AKI, patients with CA AKI have better short-and long-term outcomes.

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Section: Discussionmentioning

confidence: 90%

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

258

245

View full text Add to dashboard Cite

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“…While technological advances enable treatments for many diseases, we continue to encounter traumatic rhabdomyolysis as a result of wars, terror attacks, earthquakes, and other natural disasters1617. Mesenchymal stem cells are one of the few stem cell types that have been applied as therapeutic agents for immunomodulation and tissue repair, which highlights their potential for recovery from kidney injury6.…”

Section: Discussionmentioning

confidence: 99%

Biological Membrane-Packed Mesenchymal Stem Cells Treat Acute Kidney Disease by Ameliorating Mitochondrial-Related Apoptosis

Geng

Hong

Wang

et al. 2017

Sci Rep

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The mortality of rhabdomyolysis-induced AKI remains high because no effective therapy exists. We investigated a new therapeutic method using MSCs. The aim of this study was to investigate the therapeutic potential and anti-apoptotic mechanisms of action of MSCs in the treatment of AKI induced by glycerol in vivo and in vitro. We used Duragen as a biological membrane to pack MSCs on the glycerol-injured renal tissue in vivo. The anti-apoptotic mechanism was investigated. In vitro, HK-2 cells were incubated with ferrous myoglobin and MSCs-conditioned medium, followed by cell proliferation and apoptosis assays. We founded that packing MSCs on the injured renal tissue preserved renal function, ameliorated renal tubular lesions, and reduced apoptosis in the mice with glycerol-induced AKI. The MSC-conditioned medium improved HK-2 cell viability and inhibited apoptosis. These effects were reversed by the PI3K inhibitor LY294002. Biological membrane packing of MSCs on the renal tissue has a therapeutic rescue function by inhibiting cell apoptosis in vivo. MSCs protect renal cells from apoptosis induced by myoglobin in vitro. We have thus demonstrated MSCs reduced rhabdomyolysis-associated renal injury and cell apoptosis by activating the PI3K/Akt pathway and inhibiting apoptosis.

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“…The efforts of nephrology and critical care societies to create a unified classification system have enabled comparisons of AKI incidence and outcomes across diverse populations. The resultant epidemiological studies have shown increasing severity of AKI cases and a higher risk of death associated with AKI, in both hospital and community settings [10][11][12]. In addition, AKI is now a recognized important risk factor for new-onset chronic kidney disease (CKD), determining acceleration in the progression to end-stage renal disease [13][14][15].…”

Section: Introduction Of 0 By 25 Projectsmentioning

confidence: 99%

International Society of Nephrology 0 by 25 Project: Lessons Learned

et al. 2019

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Acute kidney injury (AKI) is a common disorder with a high risk of mortality and development of chronic kidney disease. With the validation of the recent classification systems, RIFLE in 2004 and KDIGO, in use today, our understanding of AKI has evolved. We now know that community-acquired AKI is also associated with an increased risk of worse outcomes. In addition, several epidemiological studies, including cohorts from low-income and low-middle income countries, have confirmed common risk factors for community-acquired AKI. In 2013, the International Society of Nephrology launched the 0 by 25 campaign with the goal that no patient should die from preventable or untreated AKI in low-resource areas by 2025 [Mehta et al.: Lancet 2015;385:2616–43]. The initial effort of the initiative was a meta-analysis of AKI epidemiology around the world. The second project of the 0 by 25 initiative, the Global AKI Snapshot (GSN) study, provided insights into the recognition, treatment, and outcomes of AKI worldwide [Mehta et al.: Lancet 2016;387:2017–25]. Following the GSN, a Pilot Project was designed to test whether education and a simple protocol-based approach can improve outcomes in patients at risk of community-acquired AKI in low-resource settings [Macedo: J Am Soc Nephrol 2017]. In this review, we will comment on the main findings and lessons learned from the 0 by 25 initiative.

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Differences in community, hospital and intensive care unit-acquired acute kidney injury: observational study in a nephrology service of a developing country

Abstract: AKI is a frequent and frequently fatal condition. Mortality was higher in community and ICU-acquired than hospital ward-acquired AKI.

Cited by 35 publications

References 25 publications

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Biological Membrane-Packed Mesenchymal Stem Cells Treat Acute Kidney Disease by Ameliorating Mitochondrial-Related Apoptosis

International Society of Nephrology 0 by 25 Project: Lessons Learned

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