Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure

See, Emily J; Jayasinghe, Kushani; Glassford, Neil J; Bailey, Michael; Johnson, David W.; Polkinghorne, Kevan R.; Toussaint, Nigel D; Bellomo, Rinaldo

doi:10.1016/j.kint.2018.08.036

Cited by 347 publications

(241 citation statements)

References 98 publications

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“…Systematic review with meta-analysis and recent observational studies demonstrated a reproducible association between AKI, subsequent CKD and ESRD [29][30][31][32][33]. The populations of these studies came from cardiovascular diseases, ICU, general surgical settings and general hospital settings and the causes of AKI in these patients usually were renal hypoperfusion, acute tubular injury or necrosis, renal artery stenosis and nephrotoxic drugs (such as contrast agents).…”

Section: Discussionmentioning

confidence: 99%

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

et al. 2020

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Background: The long-term predictive ability of acute kidney injury (AKI) classification based on "Kidney Disease: Improving Global Outcomes"(KDIGO) AKI diagnosis criteria has not been clinically validated in diffuse proliferative lupus nephritis (DPLN) patients with AKI. Our objective was to assess the long-term predictive value of KDIGO AKI classification in DPLN patients with AKI. Methods: Retrospective cohort study was conducted by reviewing medical records of biopsy-proven DPLN patients with AKI from the First Affiliated Hospital of Wenzhou Medical University between Jan 1, 2000 and Dec 31, 2014. Multivariate Cox regression and survival analysis were performed. Results: One hundred sixty-seven DPLN patients were enrolled,82(49%) patients were normal renal function (No AKI), 40(24%) patients entered AKI-1 stage (AKI-1), 26(16%) patients entered AKI-2 stage (AKI-2) and 19(16%) patients entered AKI-3 stage (AKI-3). The mean follow-up of all patients was 5.1 ± 3.8 years. The patient survival without ESRD of all patients was 86% at 5 years and 79% at 10 years. The patient survival rate without ESRD at 10 yr was 94.5% for No AKI patients, 81.8% for AKI-1 patients, 44.9% for AKI-2 patients and 14.6% for AKI-3 patients. The area under the ROC curve for KDIGO AKI classification to predict the primary end point was 0.83 (95% CI: 0.73-0.93) (P < 0.001). In Cox regression analysis, AKI stage was independently associated with primary endpoint, with an adjusted hazard ratio (HR) of 3.8(95% CI 2.1-6.7, P < 0.001). Conclusion: Severity of AKI based on KDIGO AKI category was associated with progression to ESRD in DPLN patients. Analytical data also confirmed the good discriminative power of the KDIGO AKI classification system for predicting long-term prognosis of DPLN patients with AKI.

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Section: Discussionmentioning

confidence: 99%

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

et al. 2020

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“…Not only are there immediate cost savings associated with reducing the likelihood of experiencing an AKI, but there are also longer-term savings due to the relationship between AKI and the development of CKD. See et al [5] found that individuals who experienced AKI were at a heightened risk of experiencing new or progressive CKD. These long-term cost savings are captured in the model.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, when modelling the impact of a healthcare technology on clinical outcomes, multiple data sources would be available to verify the clinical efficacy data being used, but that was not the case for this analysis. Finally, although evidence exists on the relationship between AKI and long-term clinical outcomes [5,12], information is limited, which means that there is also a degree of uncertainty around the relevant data included in the model. However, to address this limitation, an extreme sensitivity analysis was performed in which the main input parameters were changed by ± 50%, but the conclusion remained stable.…”

Section: Discussionmentioning

confidence: 99%

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DyeVert™ PLUS EZ System for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost–Utility Analysis

Javanbakht

Hemami

Mashayekhi

et al. 2020

PharmacoEconomics Open

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Background Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. Objectives To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3-4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. Methods A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. Results Base-case results indicate that the intervention leads to cost savings (− £435) and improved effectiveness (+ 0.028 QALYs) over the patient's lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall longterm cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. Conclusions The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3-4 undergoing angiographic procedures.

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“…Das ANV ist einer der stärksten unabhängigen Prädiktoren für sowohl die 30-Tage-als auch die 1-Jahres-Mortalität nach einer intensivmedizinischen Behandlung [8] und die wichtigste Morbiditäts-und Mortalitätsursache nach großen herzchirurgischen Operationen [9,10]. Selbst ein leichtgradiges ANV ist mit einer längeren Behandlungsdauer auf der Intensivstation, einer höheren Komplikationsrate, einer erhöhten Rate an Rehospitalisation, einem höheren Risiko eines neuen Auftretens oder einer Verschlechterung einer CKD und einem reduzierten Langzeitüberleben assoziiert [6,8,[11][12][13][14]. Dementsprechend ist das ANV auch ein relevanter Kostenfaktor in der Intensivmedizin [15,16].…”

Section: Epidemiologische Daten Zum Anv In Der Intensivmedizinunclassified

Detektion und Differenzialdiagnose des ANV in der Intensivmedizin

2019

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ZUSAMMENFASSUNGDas akute Nierenversagen (ANV) in der Intensivmedizin ist typischerweise die Folge einer schweren Minderperfusion der Nieren, welche nach Ereignissen wie Sepsis, Trauma oder großen Operationen auftritt. Davon abzugrenzen sind seltenere ANV-Formen wie Glomerulonephritiden, interstitielle Nephritiden oder thrombotische Mikroangiopathien, für die es spezifische Therapieoptionen gibt. Abhängig von der Komorbidität des Patienten, geht das Krankheitsbild zumeist mit multiplen Organdysfunktionen einher und zeigt komplikationsreiche Verläufe mit einer hohen Mortalität. Der Einsatz neuer Biomarker ermöglicht ein früheres und sensitiveres Erkennen einer Nierenfunktionsstörung und/oder einer Nierenschädigung. Für die ANV-Diagnose gilt jedoch weiterhin die etablierte Definition nach den KDIGO-Kriterien.

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Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure

Cited by 347 publications

References 98 publications

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

DyeVert™ PLUS EZ System for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost–Utility Analysis

Detektion und Differenzialdiagnose des ANV in der Intensivmedizin

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