Acute kidney injury (AKI) is increasingly common and a significant contributor to excess death in hospitalized patients. CKD is an established risk factor for AKI; however, the independent graded association of urine albumin excretion with AKI is unknown. We analyzed a prospective cohort of 11,200 participants in the Atherosclerosis Risk in Communities (ARIC) study for the association between baseline urine albumin-to-creatinine ratio and estimated GFR (eGFR) with hospitalizations or death with AKI. The incidence of AKI events was 4.0 per 1000 person-years of follow-up. Using participants with urine albumin-to-creatinine ratios <10 mg/g as a reference, the relative hazards of AKI, adjusted for age, gender, race, cardiovascular risk factors, and categories of eGFR were 1.9 (95% CI, 1.4 to 2.6), 2.2 (95% CI, 1.6 to 3.0), and 4.8 (95% CI, 3.2 to 7.2) for urine albumin-to-creatinine ratio groups of 11 to 29 mg/g, 30 to 299 mg/g, and ≥300 mg/g, respectively. Similarly, the overall adjusted relative hazard of AKI increased with decreasing eGFR. Patterns persisted within subgroups of age, race, and gender. In summary, albuminuria and eGFR have strong, independent associations with incident AKI.
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"The importance of proteinuria is apparent in the results described in a prospective cohort of 11,200 participants in the Atherosclerosis Risk in Communities (ARIC) study. The association between baseline urine albumin-tocreatinine ratio and eGFR with hospitalizations or death with AKI was examined  . Using a urine albumin-tocreatinine ratio < 10 mg/g as a reference, the relative hazards of AKI after an average of 8-years follow-up, adjusted for age, sex, race, cardiovascular risk factors, and categories of eGFR were 1.9 (95% CI 1.4–2.6), "
[Show abstract][Hide abstract]ABSTRACT: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .
Full-text · Article · Dec 2015 · Critical care (London, England)
"To emphasize the importance of this finding, both the CKD guidelines and the diabetes guidelines strongly recommend quantitative protein annually at a minimum. In addition to being a key risk factor for CKD progression [25,26], the presence of proteinuria is an important risk factor for AKI [7,9,27]. Accumulating data suggest that loss of kidney function in this population can often be non-linear and punctuated by recurrent episodes of AKI. "
[Show abstract][Hide abstract]ABSTRACT: Background
Patients with hospitalized acute kidney injury (AKI) are at increased risk for accelerated loss of kidney function, morbidity, and mortality. We sought to inform efforts at improving post-AKI outcomes by describing the receipt of renal-specific laboratory test surveillance among a large high-risk cohort.
We acquired clinical data from the Electronic health record (EHR) of 5 Veterans Affairs (VA) hospitals to identify patients hospitalized with AKI from January 1st, 2002 to December 31st, 2009, and followed these patients for 1 year or until death, enrollment in palliative care, or improvement in renal function to estimated GFR (eGFR) ≥60 L/min/1.73 m2. Using demographic data, administrative codes, and laboratory test data, we evaluated the receipt and timing of outpatient testing for serum concentrations of creatinine and any as well as quantitative proteinuria recommended for CKD risk stratification. Additionally, we reported the rate of phosphorus and parathyroid hormone (PTH) monitoring recommended for chronic kidney disease (CKD) patients.
A total of 10,955 patients admitted with AKI were discharged with an eGFR<60 mL/min/1.73 m2. During outpatient follow-up at 90 and 365 days, respectively, creatinine was measured on 69% and 85% of patients, quantitative proteinuria was measured on 6% and 12% of patients, PTH or phosphorus was measured on 10% and 15% of patients.
Measurement of creatinine was common among all patients following AKI. However, patients with AKI were infrequently monitored with assessments of quantitative proteinuria or mineral metabolism disorder, even for patients with baseline kidney disease.
"Chronic kidney disease (CKD) represents a large burden among affected patients and on the healthcare system in the U.S. Approximately 26 million U.S. individuals have impaired kidney function or albuminuria ; the majority of these patients also have other significant co-morbid conditions such as diabetes mellitus, hypertension and cardiovascular disease . Patients with CKD have significantly higher risk for hospital admissions [3-5], acute kidney injury , and cardiovascular-related death . Moreover, CKD-associated costs have increased significantly, with CKD comprising 5.8% in 2000 to now 16% in 2009 of total Medicare costs. "
[Show abstract][Hide abstract]ABSTRACT: The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed guidelines to care for patients with chronic kidney disease (CKD). While these are disseminated through the NKF's website and publications, the guidelines' usage remains suboptimal. The KDOQI Educational Committee was formed to identify barriers to guideline implementation, determine provider and patient educational needs and develop tools to improve care of patients with CKD.
An online survey was conducted from May to September 2010 to evaluate renal providers' familiarity, current use of and attitudes toward the guidelines and tools to implement the guidelines.
Most responders reported using the guidelines often and felt that they could be easily implemented into clinical practice; however, approximately one-half identified at least one barrier. Physicians and physician extenders most commonly cited the lack of evidence supporting KDOQI guidelines while allied health professionals most commonly listed patient non-adherence, unrealistic guideline goals and provider time-constraints. Providers thought that the guidelines included too much detail and identified the lack of a quick resource as a barrier to clinical implementation. Most were unaware of the Clinical Action Plans.
Perceived barriers differed between renal clinicians and allied health professionals; educational and implementation tools tailored for different providers are needed.