Nephron
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Episodes of acute kidney injury (AKI) have been associated with the development of chronic kidney disease (CKD). However, follow-up pathways for patients who have survived AKI complicating critical illness are not well established. We hypothesised that patients who had AKI requiring renal replacement therapy (RRT) in intensive care are at risk of CKD, but are rarely referred for nephrology follow-up at hospital discharge. ⋯ Follow-up of patients who required RRT for AKI in ICU is inconsistent despite evidence of a significant increase in the prevalence of CKD. There is strong justification for the development of robust pathways to identify survivors of AKI in order to detect and manage CKD and its complications.
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Acute kidney injury (AKI) is a frequent complication of hospitalized patients and is associated with poor outcomes. Hospitalized patients with AKI may need prolonged dialysis, necessitating post-hospitalization dialysis (PHD-AKI). Scarce information is available to stratify the risks and predict outcomes. This study aims to assess outcomes and identify predictors of outcomes of PHD-AKI within 90 days. ⋯ Dialysis independence of PHD-AKI patients is not uncommon. Certain clinical parameters may help predict renal outcome. Identifying predictors of renal recovery will guide further interventions, especially with the Centers for Medicare and Medicaid Services soon to allow AKI patients to be dialyzed at outpatient ESRD facilities. Ongoing biomarkers research may add further knowledge for optimum diagnosis and prognosis of AKI.
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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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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.