The Japanese clinical practice guideline for acute kidney injury 2016

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Abstract

Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention is necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.

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Most cited references 359

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Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

Glenn Chertow, Elisabeth Burdick, Melissa M Honour … (2005)

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.

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A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

Roxana Mehran, Eve Aymong, Eugenia Nikolsky … (2004)

We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown. A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase >or=25% and/or >or=0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value 75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient. The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [ or=16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively). The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.

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Acute kidney injury increases risk of ESRD among elderly.

Areef Ishani, Jay L Xue, Jonathan Himmelfarb … (2009)

Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged > or = 67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for > or = 2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.

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Author and article information

Contributors

Yoshio Terada: terada@kochi-u.ac.jp

Journal

Journal ID (nlm-ta): Clin Exp Nephrol

Journal ID (iso-abbrev): Clin. Exp. Nephrol

Title: Clinical and Experimental Nephrology

Publisher: Springer Singapore (Singapore )

ISSN (Print): 1342-1751

ISSN (Electronic): 1437-7799

Publication date (Electronic): 23 July 2018

Publication date PMC-release: 23 July 2018

Publication date (Print): 2018

Volume: 22

Issue: 5

Pages: 985-1045

Affiliations

[1 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, Department of Acute Medicine, , The University of Tokyo, ; Tokyo, Japan

[2 ]ISNI 0000 0004 1761 798X, GRID grid.256115.4, Department of Anesthesiology and Critical Care Medicine, , Fujita Health University School of Medicine, ; Toyoake, Aichi Japan

[3 ]ISNI 0000 0004 1763 1087, GRID grid.412857.d, Department of Nephrology, , Wakayama Medical University, ; Wakayama, Japan

[4 ]ISNI 0000 0001 0720 6587, GRID grid.410818.4, Department of Emergency and Critical Care Medicine, , Tokyo Women’s Medical University Yachiyo Medical Center, ; Chiba, Japan

[5 ]GRID grid.416238.a, Department of Surgery, Kidney Center, , Nikko Memorial Hospital, ; Hokkaido, Japan

[6 ]GRID grid.460111.3, Clinical Research Support Center, , Tomishiro Central Hospital, ; Okinawa, Japan

[7 ]ISNI 0000 0004 1761 798X, GRID grid.256115.4, Department of Nephrology, , Fujita Health University School of Medicine, ; Toyoake, Aichi Japan

[8 ]ISNI 0000 0001 2216 2631, GRID grid.410802.f, Department of Nephrology and General Internal Medicine, , Saitama Medical University, ; Saitama, Japan

[9 ]ISNI 0000 0001 0265 5359, GRID grid.411998.c, Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, , Kanazawa Medical University, ; Kanawaza, Ishikawa Japan

[10 ]ISNI 0000 0001 2248 6943, GRID grid.69566.3a, Department of Community Medical Supports, Tohoku Medical Megabank Organization, , Tohoku University, ; Sendai, Japan

[11 ]ISNI 0000 0004 0372 3116, GRID grid.412764.2, Division of Nephrology and Hypertension, , St. Marianna University School of Medicine, ; Kawasaki, Kanagawa Japan

[12 ]ISNI 0000 0001 0291 3581, GRID grid.267500.6, Department of Emergency and Critical Care Medicine, , University of Yamanashi School of Medicine, ; Yamanashi, Japan

[13 ]ISNI 0000 0004 1773 3964, GRID grid.471533.7, Blood Purification Unit, , Hamamatsu University Hospital, ; Hamamatsu, Japan

[14 ]Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan

[15 ]ISNI 0000 0001 2216 2631, GRID grid.410802.f, Nephrology and Blood Purification, Saitama Medical Center, , Saitama Medical University, ; Saitama, Japan

[16 ]ISNI 0000 0004 0372 2033, GRID grid.258799.8, Department of Nephrology, Graduate School of Medicine, , Kyoto University, ; Kyoto, Japan

[17 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, Department of Nephrology and Endocrinology, , The University of Tokyo, ; Tokyo, Japan

[18 ]ISNI 0000 0004 0377 2305, GRID grid.63906.3a, Division of Nephrology and Rheumatology, , National Center for Child Health and Development, ; Tokyo, Japan

[19 ]ISNI 0000 0004 0378 1551, GRID grid.415798.6, Department of Nephrology, , Shizuoka Children’s Hospital, ; Shizuoka, Japan

[20 ]ISNI 0000 0001 1014 2000, GRID grid.415086.e, Department of Nephrology and Hypertension, , Kawasaki Medical School, ; Okayama, Japan

[21 ]ISNI 0000 0004 0373 3971, GRID grid.136593.b, Health Care Division, Health and Counseling Center, , Osaka University, ; Osaka, Japan

[22 ]ISNI 0000 0001 0659 9825, GRID grid.278276.e, Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, , Kochi University, ; Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan

Article

Publisher ID: 1600

DOI: 10.1007/s10157-018-1600-4

PMC ID: 6154171

PubMed ID: 30039479

SO-VID: 33363172-fc19-412f-8f60-247c6bbc6d19

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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ScienceOpen disciplines: Nephrology

Keywords: acute kidney injury,atrial natriuretic peptide,biomarker,blood purification,long-term follow-up,nafamostat mesilate

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ScienceOpen disciplines: Nephrology

Keywords: acute kidney injury, atrial natriuretic peptide, biomarker, blood purification, long-term follow-up, nafamostat mesilate

The Japanese clinical practice guideline for acute kidney injury 2016

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Karger: Nephrology

Most cited references 359

Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

Acute kidney injury increases risk of ESRD among elderly.

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