Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

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Abstract

Purpose

Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research.

Methods

International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research.

Results

The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT).

Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT.

Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities.

Conclusion

Consensus was reached on a future research agenda for the AKI section of the ESICM.

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Most cited references 13

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Long-term risk of coronary events after AKI.

Chih-Chung Shiao, Che-Hsiung Wu, Tao Huang … (2014)

The incidence rate of AKI in hospitalized patients is increasing. However, relatively little attention has been paid to the association of AKI with long-term risk of adverse coronary events. Our study investigated hospitalized patients who recovered from de novo dialysis-requiring AKI between 1999 and 2008 using patient data collected from inpatient claims from Taiwan National Health Insurance. We used Cox regression with time-varying covariates to adjust for subsequent CKD and ESRD after discharge. Results were further validated by analysis of a prospectively constructed database. Among 17,106 acute dialysis patients who were discharged, 4869 patients recovered from dialysis-requiring AKI (AKI recovery group) and were matched with 4869 patients without AKI (non-AKI group). The incidence rates of coronary events were 19.8 and 10.3 per 1000 person-years in the AKI recovery and non-AKI groups, respectively. AKI recovery associated with higher risk of coronary events (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.36 to 2.04) and all-cause mortality (HR, 1.67; 95% CI, 1.57 to 1.79) independent of the effects of subsequent progression to CKD and ESRD. The risk levels of de novo coronary events after hospital discharge were similar in patients with diabetes alone and patients with AKI alone (P=0.23). Our results reveal that AKI with recovery associated with higher long-term risks of coronary events and death in this cohort, suggesting that AKI may identify patients with high risk of future coronary events. Enhanced postdischarge follow-up of renal function of patients who have recovered from temporary dialysis may be warranted.

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Arterial blood pressure during early sepsis and outcome.

Stefan Jochberger, Günter Luckner, Hanno Ulmer … (2009)

To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis. Retrospective cohort study. Multidisciplinary intensive care unit (ICU). A total of 274 septic patients. None. Hemodynamic, and laboratory parameters were extracted from a PDMS database. The hourly time integral of ABP drops below clinically relevant systolic arterial pressure (SAP), mean arterial pressure (MAP), and mean perfusion pressure (MPP = MAP - central venous pressure) levels was calculated for the first 24 h after ICU admission and compared with 28-day-mortality. Binary and linear regression models (adjusted for SAPS II as a measure of disease severity), and a receiver operating characteristic (ROC) analysis were applied. The areas under the ROC curve were largest for the hourly time integrals of ABP drops below MAP 60 mmHg (0.779 vs. 0.764 for ABP drops below MAP 55 mmHg; P or = 60 mmHg may be as safe as higher MAP levels during the first 24 h of ICU therapy in septic patients. A higher MAP may be required to maintain kidney function.

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Health Care Costs Associated with AKI

Scott W Klarenbach, Feng Ye, David Collister … (2017)

Background and objectives An understanding of the health care resource use associated with AKI is needed to frame the investment and cost-effectiveness of strategies to prevent AKI and promote kidney recovery. Design, setting, participants, & measurements We assembled population-based cohort of adults hospitalized in Alberta between November of 2002 and March of 2009 without ESRD or an eGFR<15 ml/min per 1.73 m 2 . Outpatient serum creatinine measurements 6 months preceding admission defined baseline kidney function, and serum creatinine during the first 14 days of hospitalization defined Acute Kidney Injury Network stage; kidney recovery defined as serum creatinine within 25% of baseline and independence from dialysis was assessed at 90 days after AKI. Health care utilization and costs (in 2015 Canadian dollars) were determined from inpatient, outpatient, and physician claims datasets during the index hospitalization, recovery period (90 days post-AKI assessment), and 3–12 months post-AKI. A fully adjusted generalized linear model regression analysis was used to estimate costs associated with AKI. Results Of 239,906 hospitalized subjects, 25,495 (10.6%), 4598 (1.9%), 2493 (1.0%), and 670 (0.3%) had Acute Kidney Injury Network stages 1, 2, 3 without dialysis, and 3 with dialysis, respectively. Greater severity of AKI was associated with incremental increases in length of stay (+2.8; 95% confidence interval, 1.4 to 4.3 to +7.4; 95% confidence interval, 7.2 to 7.5 days) and costs (+$3779; 95% confidence interval, $3555 to $4004 to +$18,291; 95% confidence interval, $15,573 to $21,009 Canadian dollars) from admission to recovery assessment (3 months). At months 3–12 postadmission, compared with subjects without AKI, AKI with kidney recovery and AKI without kidney recovery were associated with incremental costs of +$2912–$3231 and +$6035–$8563 Canadian dollars, respectively. The estimated incremental cost of AKI in Canada is estimated to be over $200 million Canadian dollars per year. Conclusions Severity of AKI, need for dialysis, and lack of kidney recovery are associated with significant health care costs in hospitalized patients and persist a year after admission. Strategies to identify, prevent, and facilitate kidney recovery are needed.

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Author and article information

Contributors

M. Ostermann:

ORCID: http://orcid.org/0000-0001-9500-9080

Marlies.Ostermann@gstt.nhs.uk

Journal

Journal ID (nlm-ta): Intensive Care Med Exp

Journal ID (iso-abbrev): Intensive Care Med Exp

Title: Intensive Care Medicine Experimental

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2197-425X

Publication date (Electronic): 7 December 2019

Publication date PMC-release: 7 December 2019

Publication date Collection: December 2019

Volume: 7

Electronic Location Identifier: 69

Affiliations

[1 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Department of Critical Care, , King’s College London, Guy’s & St Thomas’ Hospital, ; London, UK

[2 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), ; Lausanne, Switzerland

[3 ]ISNI 0000 0001 2198 4166, GRID grid.412180.e, Department of Anesthesiology and Critical Care Medicine, , Edouard Herriot Hospital, Hospices Civils de Lyon, ; Lyon, France

[4 ]ISNI 0000 0001 0942 9821, GRID grid.11804.3c, Aneszteziológiai és Intenzív Terápiás Klinika, Semmelweis Egyetem, ; Budapest, Hungary

[5 ]ISNI 0000000090126352, GRID grid.7692.a, Department of Intensive Care Medicine, , University Medical Center Utrecht, ; Utrecht, The Netherlands

[6 ]ISNI 0000 0001 2300 6614, GRID grid.413328.f, Medical ICU, Saint-Louis University Hospital, AP-HP, ; Paris, France

[7 ]ISNI 0000 0001 0372 6120, GRID grid.412946.c, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, , University of Surrey and Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, ; Guildford, UK

[8 ]ISNI 0000 0004 0593 7118, GRID grid.42399.35, Service d’Anesthesie-Reanimation SUD, CHU de Bordeaux, Hôpital Magellan, ; Bordeaux, France

[9 ]ISNI 0000 0000 8853 2677, GRID grid.5361.1, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, , Medical University Innsbruck, ; Innsbruck, Austria

[10 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Anesthesiology and Peri-operative Care, , University of California, ; San Francisco, USA

[11 ]ISNI 0000 0001 2171 1133, GRID grid.4868.2, Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, and William Harvey Research Institute, , Queen Mary University of London, ; London, UK

[12 ]ISNI 0000 0004 0551 4246, GRID grid.16149.3b, Department of Anesthesiology, Intensive Care and Pain Medicine, , University Hospital Münster, ; Münster, Germany

[13 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Intensive Care Unit, Ghent University Hospital, , Ghent University, ; Ghent, Belgium

[14 ]ISNI 0000 0000 8597 7208, GRID grid.434261.6, Research Foundation-Flanders (FWO), ; Brussels, Belgium

Author information

M. Ostermann http://orcid.org/0000-0001-9500-9080

Article

Publisher ID: 280

DOI: 10.1186/s40635-019-0280-z

PMC ID: 6898702

PubMed ID: 31811522

SO-VID: c7a82c25-c53d-4115-83ab-41a8025202c2

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.

History

Date received : 22 October 2019

Date accepted : 8 November 2019

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Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

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Abstract

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Karger: Nephrology

Most cited references 13

Long-term risk of coronary events after AKI.

Arterial blood pressure during early sepsis and outcome.

Health Care Costs Associated with AKI

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