EuAsia Day 2: AKI

Epidemiology of AKI and outcome (YS Guh)

AKI characterised by rapid decrease in renal excretory function

Continuum of injury as it develops which corresponds to worsening prognosis

Multiple definitions with limitations e.g. all depend on urine output and creatinine

Most common cause of AKI – SEPSIS

Increase mortality and morbidity in AKI

CKD is a major risk factor for AKI

The quicker pts recover from the AKI, the better the outcome

2017-04-07 10.57.13 2017-04-07 10.56.51 2017-04-07 11.09.29

References

RIFLE criteria for AKI

AKIN criteria for AKI 

KDIGO definitions

Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study.

Recovery after Acute Kidney Injury (2017)

 

Biomarkers for AKI: what, why, how (@erichoste)

Multiple biomarkers available and indicate different things

May be improve the diagnosis of AKI

Not a single delegate in the room uses biomarkers in clinical practice

Interesting but how does it translate to clinical outcomes/management is currently unknown

2017-04-07 11.11.00 2017-04-07 11.23.08

 

Interactions of AKI with other organs (K Chan)

Affects all organ systems

5 types of cardiorenal syndromes

Relationship with AKI and brain is 2 way

2017-04-07 11.31.47 2017-04-07 11.44.21

 

References:

Acute kidney injury: short-term and long-term effects 

Cardiorenal syndromes

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit 

 

Contrast-associated AKI: an issue? (M Ostermann)

Incidence depends on pt groups and criteria for AKI

Most of work done in cardiac patients

Most contrast agents have iodine, high isomolarity compared to plasma and have high viscosity

Impact of contrast – contrast-induced AKI associated with poor short and long term outcomes after PCI for STEMI (HORIZONS-AMI) BUT significant limitations

Newer evidence suggest the risk is for pts who had poor renal function prior OR no risk at all

2017-04-07 12.01.05 2017-04-07 12.13.19 2017-04-07 12.14.31

 

References

Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy.

Acute kidney injury in the critically ill: is iodinated contrast medium really harmful?

Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study.

Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis.

Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial