World Kidney Day 2013 Highlights Acute Kidney Injury

Acute kidney injury (AKI) is a serious and growing public health problem that is encountered in the hospital setting. AKI is associated with a higher short-term risk of in-hospital death, and AKI-associated costs have been estimated at $10 billion annually in the United States, due in part to extended hospital length of stays and use of renal replacement therapies. Survivors of episodes of AKI remain at increased risk of development and progression of chronic kidney disease, end stage kidney failure, and death. Unfortunately, at present, there exist no specific therapies aimed at preventing or treating AKI and its associated complications with the exception of supportive care, including renal replacement therapies.

Launched in 2006, World Kidney Day broadcasts an annual message about kidney disease to the public, government health officials, and health care providers, including general practitioners. Over the past seven years, this effort has focused on early detection of kidney disease, kidney protection measures, and kidney organ donation. This year, World Kidney Day—March 14, 2013—focuses on AKI to raise awareness and promote discussion, education, and policy development with the hope of improving prevention and treatment of this condition.

The AKI Advisory Group is leading ASN’s efforts to commemorate the day. In preparation for World Kidney Day 2013, the AKI Advisory Group conducted a large systematic review and meta-analysis aimed at estimating the worldwide incidence of AKI and its stages of severity and associated mortality. The review also aims to describe geographic variations according to countries, regions, and their economies. The advisory group also completed a narrative review on the importance of transitions of care following hospital episodes of AKI calling for studies aimed at identifying patients at risk for developing chronic kidney disease and in need of targeted interventions. To further raise awareness of AKI, on World Kidney Day, the AKI Advisory Group will conduct a survey of nephrologists to determine the number of cases of AKI seen in the United States on one particular day. This survey may help assess the burden of AKI as a function of the overall practice of nephrology (see more below).

The epidemiology of AKI has undergone a dramatic shift in the past two decades. Medical providers increasingly understand that AKI is independently associated with poor patient outcomes. The major clinical contexts studied have included those in which the timing of AKI is known and predictable (e.g., cardiopulmonary bypass) or when mortality is very high, such as in patients admitted to the intensive care unit with septic shock.

Numerous studies such as RIFLE and AKIN, as well as improved criteria for assessing AKI (KDIGO) have demonstrated that AKI may manifest as a secondary syndrome associated with another system illness and/or its treatment. Recently, increased attention has focused on nephrotoxic agents used for diagnostic purposes, including iodinated contrast agents required for imaging studies, as well as the multiple nephrotoxins prescribed to treat underlying illness or symptoms, which range from non-steroidal inflammatory drugs, antimicrobials, to chemotherapeutic agents.

Recent data show that over 80 percent of hospitalized patients are exposed to at least one nephrotoxic medication. Nephrotoxic medication–associated AKI is often non-oliguric, so clinicians should monitor kidney function closely in the at-risk patient receiving a nephrotoxin. Given the increased evidence that AKI can lead to CKD, increased awareness of AKI risks and outcomes by non-nephrologists, and their collaboration with nephrologists, can improve outcomes.

As understanding of the epidemiology of AKI has emerged, so too has the importance of characterizing the public health burden of AKI, particularly in regard to its daily impact. Therefore, on World Kidney Day 2013 ASN will conduct a survey of its U.S. members to provide a snapshot of AKI on this one day. Participants will be asked to keep track of the number of patients with AKI they see in the hospital relative to the total number of cases seen.

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Although much is known about the epidemiology of AKI, virtually nothing is known about the burden of AKI from a nephrologist’s practice perspective. A picture of a “day in the life of AKI” will include an estimate of the number of cases of AKI, the number requiring renal replacement therapy, and the amount of in-hospital nephrology practice devoted to the care of patients with AKI.

All U.S. nephrologists are encouraged to participate, whether or not they see patients on World Kidney Day, as questions regarding overall practice related to AKI will also be asked. The information obtained in this survey will further raise awareness of AKI and its impact on public health. In summary, AKI continues to present a formidable challenge to health care providers and patients, and requires innovation in the prevention and treatment of this condition. With the launch of its new 2013 campaign, the AKI Advisory Group hopes to galvanize health care professionals and policy makers, in close collaboration with the public, to design better and safer health care delivery systems that focus on preserving kidney health through prevention and early detection and treatment of AKI, with the goal of mitigating the long-term costly burden of chronic kidney disease.

Notes

[1] Sarah Faubel, MD, is affiliated with the Division of Nephrology, University of Colorado and Denver Veterans Administration Medical Center. Stuart Goldstein, MD, is affiliated with the Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center. Bertrand Jaber, MD, FASN, is affiliated with the Department of of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth’s Medical Center, Boston, and the Department of Medicine, Tufts University School of Medicine.

March 2013 (Vol. 5, Number 3)