Acute kidney injury increases risk of ESRD among elderly.
ABSTRACT Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged > or = 67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for > or = 2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.
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ABSTRACT: The outcomes of acute kidney injury (AKI) are well appreciated. However, valid indicators of high quality processes of care for AKI after major surgery are lacking. To identify indicators of high quality processes of care related to AKI prevention, identification, and management after major surgery. A three stage modified Delphi process. The study was conducted in Alberta, Canada using an online format. A panel of care providers from surgery, critical care, and nephrology. The degree of validity of candidate indicators were rated by panelists on a 7-point Likert scale that ranged from "strongly disagree" to "strongly agree". A focused literature review was performed to identify candidate indicators. A modified Delphi process, with three rounds, was used to obtain expert consensus on the validity of potential process of care quality indicators. Thirty-three physicians participated (6 from surgery, 10 from critical care, and 17 from nephrology). A list of 58 potential process of care quality indicators for AKI after surgery was generated including 28 indicators from the initial literature review and 30 indicators suggested by panelists. Following the third round of questioning, 40 process of care indicators were identified with a high level of agreement for face validity; 16 of these reached high consensus among all panelists. The consensus of panelists from Alberta, Canada may not be generalizable to other settings. The modified Delphi process did not focus on the feasibility of measuring these process indicators. These indicators can be used to measure and improve the quality of care for AKI after major surgery.12/2015; 2(1). DOI:10.1186/s40697-015-0047-8
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ABSTRACT: Acute kidney injury (AKI) represents a major complication of cardiac surgery. Our aim was to evaluate, in patients undergoing continuous renal replacement therapy (CRRT) for cardiac surgery-associated AKI (CS-AKI), prognostic factors related to in-hospital survival and renal function recovery to independence from RRT. We conducted a retrospective analysis in patients with severe CS-AKI who underwent CRRT for at least 48 h. The sequential organ failure assessment (SOFA) score was calculated on a daily basis to evaluate illness severity throughout the intensive care unit (ICU) stay. In 264 patients (age 66.4 ± 11.7 years, 192 males), 30-day survival was 57.6 % while survival to discharge from the hospital was 40.5 %. Renal function recovery occurred in 96.3 % of survivors and in 13.4 % of non-survivors (p < 0.001). Multivariate analysis selected advancing age, oliguria, sepsis and the highest level of SOFA score within the first week of CRRT (SOFA-max) as independent prognostic factors for failure to recover renal function. Female gender was associated with a higher probability of survival, while higher serum creatinine at the start of CRRT, oliguria, sepsis and SOFA-max were independently associated with mortality. The subgroup of patients with a day-1 SOFA score above the median (≥10) showed a lower probability of survival and a lower cumulative incidence of renal function recovery. In a selected population of patients with severe CS-AKI requiring RRT, short-term outcomes appear strongly associated with the worst grade of illness severity during the first week of CRRT, thus reflecting the sequential occurrence of additional major complications during ICU stay. Renal function recovery and in-hospital survival appear mutually linked, sharing oliguria, sepsis and SOFA score as the main determinants of both outcomes.Journal of nephrology 05/2015; DOI:10.1007/s40620-015-0213-1 · 2.00 Impact Factor
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ABSTRACT: To provide information on the role of pharmacists in nonsteroidal anti-inflammatory drug (NSAID) avoidance in high-risk patients. Nonprescription analgesics such as ibuprofen and naproxen are widely used by Americans. These nonsteroidal anti-inflammatory drugs (NSAIDs) are available in large quantities in pharmacies and also in wholesale stores, gas stations, and convenience stores. In addition, more than 111 million people use prescription NSAIDs each year, including many older Americans. NSAIDs may seem innocuous, but they carry a significant risk of disrupting blood flow to the kidneys and thus precipitating acute kidney injury (AKI). Episodes of AKI can lead to costly hospitalizations and long-term consequences such as new-onset chronic kidney disease (CKD) or more rapid progression of existing CKD. Most cases of NSAID-induced AKI can be avoided by recognizing high-risk patients and counseling them on appropriate use of these medications. Community pharmacy-based NSAID counseling and education at the point of prescription dispensing or nonprescription purchase could complement and augment NSAID-induced AKI education provided by other members of the health care team to high-risk patients. NSAID use is widespread and severely compromises effective renal perfusion in high-risk patients. The community pharmacist can play a pivotal role in NSAID avoidance education to prevent potential episodes of AKI that have long-term consequences for patients.Journal of the American Pharmacists Association: JAPhA 12/2014; 55(1):e15-e25. DOI:10.1331/JAPhA.2015.15506 · 0.93 Impact Factor