Nephrologist Interventions to Avoid Kidney Replacement Therapy in Acute Kidney Injury

Chávez-Íñiguez, Jonathan S; Maggiani-Aguilera, Pablo; Pérez-Flores, Christian; Granado, Rolando Claure-Del; Torre-Quiroga, Andrés E De la; Gonzalez, Alejandro Martínez-Gallardo; Navarro-Blackaller, Guillermo; Medina-González, Ramón; Raimann, Jochen G.; Yanowsky-Escatell, Francisco Gerardo; García-García, Guillermo

doi:10.1159/000517615

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…Our group showed that uid adjustment was associated with a 42% risk reduction in initiation of KRT (37); it could be that, through this uid adjustment, sK + can decrease and thus improve the clinical course of these patients. In this line, utilization of balanced solutions with physiological concentrations of chloride (Ringer's lactate and Plasmalyte) prevents the development of metabolic acidosis and is associated with lower sK + levels compared to NaCl 0.9% (38).…”

Section: Discussionmentioning

confidence: 84%

Serum Potassium Trajectory during Acute Kidney Injury and Mortality Risk

Chávez-Íñiguez¹,

Maggiani-Aguilera²,

Quevedo³

et al. 2023

Nephron

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Background: The association between potassium (sK) level trajectory and mortality or the need for kidney replacement therapy (KRT) during acute kidney injury (AKI) has not been adequately explored. Methods: In this prospective cohort, AKI patients admitted to the Hospital Civil de Guadalajara were enrolled. Eight groups based on the sK (mEq/L) level trajectories during 10 days of hospitalization were created, (1) normokalemia (normoK), defined as sK between 3.5-5.5; (2) hyperkalemia to normoK; (3) hypokalemia to normoK; (4) fluctuating potassium; (5) persistent hypoK; (6) normoK to hypoK; (7) normoK to hyperK; (8) persistent hyperK. We assessed the association of sK trajectories with mortality and the need for KRT. Results: A total of 311 AKI patients were included. The mean age 52.6 years, and 58.6% were male. AKI stage 3 was present in 63.9%. KRT started in 36% patients, and 21.2% died. After adjusting for confounders, 10-day hospital mortality was significantly higher in group 7 and 8 (OR, 1.35 and 1.61, p = <0.05, for both, respectively), and KRT initiation was higher only in group 8 (OR 1.38, p = < 0.05) compared with group 1. Mortality in different subgroups of patients in group 8 did not change the primary results. Conclusion: In our prospective cohort, most patients with AKI had alterations in sK+. NormoK to hyperK and persistent hyperK were associated with death, while only persistent hyperK was correlated with the need for KRT.

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Section: Discussionmentioning

confidence: 84%

Serum Potassium Trajectory during Acute Kidney Injury and Mortality Risk

Chávez-Íñiguez¹,

Maggiani-Aguilera²,

Quevedo³

et al. 2023

Nephron

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“…In high-risk patients for AKI, the doses of nephrotoxic drugs and other drugs should be strictly controlled [ 12 ]. Recently, an observational and retrospective study [ 41 ] analyzed 5 interventions of the nephrology team with the potential to meliorate AKI outcomes, including the fluid adjustment and nephrotoxic withdrawal, etc. It reported that only fluid management lowered risk of starting renal replacement therapy (RRT) and progression to AKI stage 3, and none of the interventions reduced the risk of death in AKI patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of care bundles for acute kidney injury: A systematic review and meta-analysis

Zhang,

Chen,

Zhou

et al. 2024

PLoS ONE

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Purpose Acute kidney injury (AKI) is frequent among in-hospital patients with high incidence and mortality. Implementing a series of evidence-based AKI care bundles may improve patient outcomes by reducing changeable standards of care. The aim of this meta-analysis was therefore to appraise the influences of AKI care bundles on patient outcomes. Materials and methods We explored three international databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) for studies from databases inception until November 30, 2022, comparing the impact of different AKI care bundles with usual standards of care in patients with or at risk for AKI. The study quality of non-randomized controlled trials and randomized controlled trials was evaluated by the NIH Study Quality Assessment Tool and the Cochrane risk of bias tool. Heterogeneity between studies was appraised by Cochran’s Q test and I2 statistics. The possible origins of heterogeneity between studies were assessed adopting Meta-regression and subgroup analyses. Funnel plot asymmetry and Egger regression and Begg correlation tests were performed to discover potential publication bias. Data analysis was completed by software (RevMan 5.3 and Stata 15.0). The primary outcome was short- or long-term mortality. The secondary outcomes involved the incidence and severity of AKI. Results Sixteen studies containing 25,690 patients and 25,903 AKI episodes were included. In high-risk AKI patients determined by novel biomarkers, electronic alert or risk prediction score, the application of AKI care bundles significantly reduced the AKI incidence (OR, 0.71; 95% CI, 0.53–0.96; p = 0.02; I2 = 84%) and AKI severity (OR, 0.59; 95% CI, 0.39–0.89; p = 0.01; I2 = 65%). No strong evidence is available to prove that care bundles can significantly reduce mortality (OR, 1.16; 95% CI, 0.58–2.30; p = 0.68; I2 = 97%). Conclusions The introduction of AKI care bundles in routine clinical practice can effectively improve the outcomes of patients with or at-risk of AKI. However, the accumulated evidence is limited and not strong enough to make definite conclusions.

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“…Early consults with nephrology have shown potential benefit by lowering risk of progression to AKI stage 3 through interventions such as early fluid adjustment. 18 Hospitals may consider implementing an AKI alert system using existing EMR infrastructure to generate automated consultations with the nephrology division, which has shown to be associated with improved rate of recovery from AKI. 19 Ultimately, these findings also suggested that the role of the nephrologist in assisting in the care of children with AKI when RRT is not required, is unclear to other healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes

Che

D’Arienzo

Dart

et al. 2023

Can J Kidney Health Dis

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Background: Acute kidney injury (AKI) in critically ill children is associated with increased risk for short- and long-term adverse outcomes. Currently, there is no systematic follow-up for children who develop AKI in intensive care unit (ICU). Objective: This study aimed to assess variation regarding management, perceived importance, and follow-up of AKI in the ICU setting within and between healthcare professional (HCP) groups. Design: Anonymous, cross-sectional, web-based surveys were administered nationally to Canadian pediatric nephrologists, pediatric intensive care unit (PICU) physicians, and PICU nurses, via professional listservs. Setting: All Canadian pediatric nephrologists, PICU physicians, and nurses treating children in the ICU were eligible for the survey. Patients: N/A. Measurements: Surveys included multiple choice and Likert scale questions on current practice related to AKI management and long-term follow-up, including institutional and personal practice approaches, and perceived importance of AKI severity with different outcomes. Methods: Descriptive statistics were performed. Categorical responses were compared using Chi-square or Fisher’s exact tests; Likert scale results were compared using Mann-Whitney and Kruskal-Wallis tests. Results: Surveys were completed by 34/64 (53%) pediatric nephrologists, 46/113 (41%) PICU physicians, and 82 PICU nurses (response rate unknown). Over 65% of providers reported hemodialysis to be prescribed by nephrology; a mix of nephrology, ICU, or a shared nephrology-ICU model was reported responsible for peritoneal dialysis and continuous renal replacement therapy (CRRT). Severe hyperkalemia was the most important renal replacement therapy (RRT) indication for both nephrologists and PICU physicians (Likert scale from 0 [not important] to 10 [most important]; median = 10, 10, respectively). Nephrologists reported a lower threshold of AKI for increased mortality risk; 38% believed stage 2 AKI was the minimum compared to 17% of PICU physicians and 14% of nurses. Nephrologists were more likely than PICU physicians and nurses to recommend long-term follow-up for patients who develop any AKI during ICU stay (Likert scale from 0 [none] to 10 [all patients]; mean=6.0, 3.8, 3.7, respectively) ( P < .05). Limitations: Responses from all eligible HCPs in the country could not obtained. There may be differences in opinions between HCPs that completed the survey compared to those that did not. Additionally, the cross-sectional design of our study may not adequately reflect changes in guidelines and knowledge since survey completion, although no specific guidelines have been released in Canada since survey dissemination. Conclusions: Canadian HCP groups have variable perspectives on pediatric AKI management and follow-up. Understanding practice patterns and perspectives will help optimize pediatric AKI follow-up guideline implementation.

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Nephrologist Interventions to Avoid Kidney Replacement Therapy in Acute Kidney Injury

Cited by 6 publications

References 36 publications

Serum Potassium Trajectory during Acute Kidney Injury and Mortality Risk

Serum Potassium Trajectory during Acute Kidney Injury and Mortality Risk

Effect of care bundles for acute kidney injury: A systematic review and meta-analysis

Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes

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