KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort

Sawhney, Simon; Fluck, Nick; Fraser, Simon; Marks, Angharad; Prescott, Gordon; Roderick, Paul; Black, Corri

doi:10.1093/ndt/gfw052

Cited by 72 publications

(88 citation statements)

References 21 publications

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“…Alarmingly however the progression to CKD (estimated glomerular filtration rate <60 mL/min/1.73 m 2 , persisting for >3 months) following an episode of CA H -AKI has been reported as high as 73.8% at 5 years [7] . All AKI, including CA H -AKI and AKI identified and managed in primary care, showed similar and very poor long-term outcomes in a recent Scottish population cohort study [12] . LOS in hospital is greater in patients with any AKI and increases with AKI severity [1,3] .…”

Section: Resultsmentioning

confidence: 76%

“…Other studies confirm significantly longer LOS with CA H -AKI compared to non-AKI [8] but the presence of HA-AKI has a greater impact on LOS [4,6] . Younger age and fewer comorbid conditions in the CA H -AKI cohort could account for this [4,6,12] . The presence of AKI in a hospitalized patient has been shown to significantly increase healthcare costs [13] ; although this has not been investigated in the CA H -AKI population specifically it is likely that CA H -AKI has significant healthcare costs and patient flow implications given its effect on mortality and LOS.…”

Section: Resultsmentioning

confidence: 96%

“…When defining AKI as an increase of 50% or more in SCr, the incidence was low at 0.09% [14] . Sawhney et al [12] reported 4,550 AKI episodes, with 1,771 (38.9% of all AKI, 3.48% of total population) being identified in primary care or on the first day of hospital admission. Barton et al [16] used AKIN criteria and identified 991 AKI episodes (0.4% of all creatinine blood tests requested, 991 of 246,662) over a 1-year period.…”

Section: C-aki Identified In Primary Carementioning

confidence: 99%

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The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Emmett

Tollitt

McCorkindale

et al. 2017

Nephron

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Background: Almost two-thirds of patients with acute kidney injury (AKI) damage their kidneys whilst in the community. This paper aims to review existing data on incidence, mortality, and morbidity of AKI within the community and explore the evidence base for primary care strategies aimed at reducing incidence and improving early detection and management of AKI. Methods: A literature search was carried out using PubMed; key words including AKI, primary care, community acquired, and electronic alerts (e-alerts) were used to capture relevant data. Results: Incidence of AKI developing in the community is variable between studies due to differences in AKI definition. Community-acquired AKI (CA-AKI) but identified in hospital (CA_H-AKI) is more prevalent than hospital-acquired AKI and increases short- and long-term mortality and length of stay in hospital. CA-AKI identified in primary care is less severe than CA_H-AKI but is associated with increased mortality. The use of e-alerts has good diagnostic accuracy for detecting AKI but their impact on outcomes in secondary care remains uncertain; it is likely that they should be complemented with other interventions to improve management. Evidence has not yet emerged regarding the effects of e-alerts on outcomes in primary care. Conclusion: Given the significance of developing AKI in the community, strategies to aid early detection and promote prevention are warranted. A multifaceted approach combining e-alerts, educational programs, and care bundles across the interface between primary and secondary care has the potential to improve outcomes in the future.

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Section: Resultsmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 96%

Section: C-aki Identified In Primary Carementioning

confidence: 99%

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The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Emmett

Tollitt

McCorkindale

et al. 2017

Nephron

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“…A third of all AKI events are already present at admission or develop 24 h after hospital admission [6] . Therefore, early recognition is mandatory.…”

mentioning

confidence: 99%

Acute Kidney Injury Risk Assessment and the Nephrology Rapid Response Team

2016

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Acute kidney Injury (AKI) is a serious medical condition affecting more than 10 million people around the world annually and resulting in poor outcomes. It has been suggested that late recognition of the syndrome may lead to delayed interventions with increased morbidity and mortality. Early diagnosis and timely therapeutic strategies may be the cornerstone of future improvement in outcomes. The purpose of this article is to provide a practical model to identify patients at high risk for AKI in different environments, with the goal to prevent AKI. We describe the AKI Risk Assessment (ARA) as a proposed algorithm that systematically evaluates the patient in high-risk situations of AKI in a simple way no matter where the patient is located, and allows different medical specialists to approach patients as a team with a nephrologist to improve outcomes. The goal of the nephrology rapid response team (NRRT) is to prevent AKI or start treatment if AKI is already diagnosed as a consequence of progressive events that can lead to progressive deterioration of kidney tissues and eventual decline in renal function and to ensure appropriate follow-up of patients at risk for progressive chronic kidney disease after the episode of AKI. Prevention is the key to avoid mortality and morbidity associated with AKI. Integration of these assessment tools in a global methodology that includes a multi-disciplinary team (NRRT) is critical to success. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452402.

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“…A Veterans Affairs Center study revealed that 23.6% of patients hospitalized from 2004 to 2005 in Upstate New York had AKI, and approximately 78% of those instances were attributed to CA-AKI, indicating that primary care clinics should regularly screen for AKI before the patient deteriorates and requires hospitalization [9]. Additionally, CA-AKI has been shown to be predictive of a poor clinical course, progression to CKD, and death, with 5-year mortality as high as 64% [4, 23]. Among elderly Medicare beneficiaries (≥67 years), Ishani et al [24] documented that the risk of developing end stage renal disease after AKI was 13 times higher than for those without AKI.…”

Section: Discussionmentioning

confidence: 99%

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Tecson¹,

Hashemi²,

Afzal³

et al. 2019

Cardiorenal Med

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Objectives: Because patients with hospital-acquired acute kidney injury (AKI) are at risk for subsequent development of heart failure (HF) and little is known about the relation between community-acquired AKI (CA-AKI) and HF, we sought to determine if CA-AKI is a risk factor for incident HF hospitalization. Methods: We utilized Baylor Scott & White Health databases at the primary care and inpatient hospitalization levels to identify adults without a prior history of HF who had 2 or more serum creatinine measurements within 13 months in the primary care setting. We defined CA-AKI as a serum creatinine increase ≥0.3 mg/dL or ≥1.5 times the baseline for consecutive values within a 13-month period. We created a flag for de novo HF hospitalization at 90, 180, and 365 days following CA-AKI evaluation. Results: In the analyses, 210,895 unique adults were included, of whom 5,358 (2.5%) had CA-AKI. Those with CA-AKI had higher rates of comorbidities, higher rate of males (48 vs. 42%, p < 0.001), and were older (61.5 [50.3, 73.1] vs. 54.1 [42.8, 64.7] years, p < 0.001) than those who did not have CA-AKI. In total, 607 (0.3%), 833 (0.4%), and 1,089 (0.5%) individuals had an incident HF hospitalization in the 90, 180, and 365 days following the CA-AKI evaluation, respectively. After adjusting for demographic and clinical characteristics, patients with CA-AKI had >2 times the risk of de novo HF hospitalization compared with patients who did not have CA-AKI (90 days: 2.35 [1.83–3.02], p < 0.001; 180 days: 2.52 [2.04–3.13], p < 0.001; 365 days: 2.16 [1.77–2.64], p < 0.001). These multivariable models yielded strong predictive abilities, with the areas under the receiver-operating characteristic curve >0.90. Conclusion: After controlling for baseline and clinical characteristics, patients with CA-AKI were at approximately twofold the risk of de novo HF hospitalization (within 90, 180, and 365 days) compared with those who did not have CA-AKI. Hence, detecting CA-AKI may provide an opportunity for early intervention at the primary care level to possibly delay HF development.

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KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort

Cited by 72 publications

References 21 publications

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Acute Kidney Injury Risk Assessment and the Nephrology Rapid Response Team

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

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