Nephron
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Despite advances in the approach to cure acute kidney injury (AKI), including definition, classification and treatment methods, there are no standard criteria to withdraw dialysis in the setting of improving AKI. We conducted this survey to elucidate parameters that United States (US) nephrologists used to determine when to stop dialysis with improving renal function in AKI. We hypothesized that there would be a difference in approach to weaning a patient off dialysis based on years in practice or the number of cases of AKI treated per year. ⋯ Resolution of oliguria was the commonest factor used to help deciding to stop dialysis in improving AKI. However, considerable variation was noted among US nephrologists who participated in this survey, regarding what criteria they used to withdraw dialysis in the setting of improving AKI. These results call for more studies in withdrawing dialysis in the setting of AKI that could lead to guideline formulation.
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Hospital-associated acute kidney injury (HA-AKI) is associated with increased inpatient mortality. Our objective was to categorize HA-AKI based on the timing of minimum and peak inpatient serum creatinine (sCr) and describe the association with inpatient mortality. ⋯ Risk of short-term inpatient mortality is associated with AKI, and this risk is attenuated with recovery of kidney function in the hospital. Systematic surveillance with repeated inpatient sCr values is needed to assess the short- and long-term consequences of HA-AKI.
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Acute kidney injury (AKI) complicates 15-20% of hospitalizations, and AKI survivors are at increased risk of chronic kidney disease and death. However, less than 20% of patients see a nephrologist within 3 months of discharge, even though a nephrologist visit within 90 days of discharge is associated with enhanced survival. To address this, we established an AKI Follow-Up Clinic and characterized the patterns of care delivered. ⋯ An AKI Follow-Up Clinic with an automatic referral process increased the proportion of patients seen at 90 days, but not 30 days post discharge. Being seen in the AKI Follow-Up Clinic was associated with interventions in most patients. Future research is needed to evaluate the effect of the AKI Follow-Up Clinic on patient-centered outcomes, but physicians should be aware that AKI survivors may benefit from close outpatient follow-up and a multipronged approach to care similarly for other high-risk populations.
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Postoperative acute kidney injury (AKI) is not only one of the most common postoperative complications but is also associated with increased in-hospital mortality, decreased survival for up to 10 years after surgery and an increased risk for progression to chronic kidney disease and hemodialysis. Most of the studies that have developed clinically applicable risk models for prediction of AKI have focused on the most severe stages of AKI and rarely on less severe stages defined by consensus definitions. Furthermore, although multiple physiological signals are continuously recorded as a part of intraoperative management, their use for the development of risk models for AKI has been limited. Accurate risk stratification of patients in real time would enable the selection of optimal therapy in a timely fashion to prevent AKI altogether, or to mitigate the effects of the complication even before symptoms arise and can be tailored to a patients' personal clinical profile.