insufficienza renale acuta nosocomiale e in comunità · insufficienza renale acuta nosocomiale e...

Insufficienza renale acuta nosocomiale e in comunità

Giuseppe GrandalianoUOC di Nefrologia, Dialisi e

Trapianto

Definitions proposed for the identification and staging of acute

kidney injury

Acute kidney injury: the global burden

Community-acquired AKIAcute kidney injury diagnose at hospital

admission

Hospital acquired AKIAcute kidney injury developed during the

hospital stay

KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a

large population cohort

Sawhney S et al. Nephrol Dial Transplant (2016) 31: 922–929

Incidence and presentation

Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired

Acute Kidney Injury

Hsu C-N et al. Medicine 95(19):e3674, 2016

Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired

Acute Kidney Injury

Hsu C-N et al. Medicine 95(19):e3674, 2016

Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired

Acute Kidney Injury

Hsu C-N et al. Medicine 95(19):e3674, 2016

Oliguria

Huang L et al. Kidney Blood Press Res 2019;44:879-896

Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired

Acute Kidney Injury: A Meta-Analysis

Need for HD

Huang L et al. Kidney Blood Press Res 2019;44:879-896

Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired

Acute Kidney Injury: A Meta-Analysis

Risk factors

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott A et al. Clin J Am Soc Nephrol 9: 1007-1014, 2014

Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults

Xu X et al. Clin J Am Soc Nephrol 10: 1510–1518, 2015

Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults

Xu X et al. Clin J Am Soc Nephrol 10: 1510–1518, 2015

Seasonality of acute kidney injury incidence and mortality among hospitalized patients

Iwagami M et al. Nephrol Dial Transplant 33: 1354-1362, 2018

Seasonality of acute kidney injury incidence and mortality among hospitalized patients

Iwagami M et al. Nephrol Dial Transplant 33: 1354-1362, 2018

Seasonality of acute kidney injury incidence and mortality among hospitalized patients

Iwagami M et al. Nephrol Dial Transplant 33: 1354-1362, 2018

Seasonality of acute kidney injury incidence and mortality among hospitalized patients

Iwagami M et al. Nephrol Dial Transplant 33: 1354-1362, 2018

Seasonality of acute kidney injury incidence and mortality among hospitalized patients

Iwagami M et al. Nephrol Dial Transplant 33: 1354-1362, 2018

Causes

Incidence, Severity, and Outcomes of AKI Associated with Dual Renin-Angiotensin System Blockade

Palevsky P et al. Clin J Am Soc Nephrol 11: 1944-1953, 2016

Incidence, Severity, and Outcomes of AKI Associated with Dual Renin-Angiotensin System Blockade

Palevsky P et al. Clin J Am Soc Nephrol 11: 1944-1953, 2016

Combined use of NSAID with diuretics and/or RAS inhibitors in the community increases the risk of AKI

Dreischulte T et al. Kidney Int 88: 396-403, 2015

Combined use of NSAID with diuretics and/or RAS inhibitors in the community increases the risk of AKI

Dreischulte T et al. Kidney Int 88: 396-403, 2015

Increased prevalence of acute tubulointerstitial nephritis

Goicoechea et al. Nephrol Dial Transplant 28: 112-115, 2013

Increased prevalence of acute tubulointerstitial nephritis

Goicoechea et al. Nephrol Dial Transplant 28: 112-115, 2013

Clinical and laboratory features at presentation in patients with AIN

Valluri et al. Q J Med 2014, doi:10.1093/qjmed/hcu236

Valluri et al. Q J Med 2014, doi:10.1093/qjmed/hcu236

Acute interstitial nephritis with proton pump inhibitor use

Outcomes

Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired

Acute Kidney Injury

Hsu C-N et al. Medicine 95(19):e3674, 2016

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott A et al. Clin J Am Soc Nephrol 9: 1007-1014, 2014

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott A et al. Clin J Am Soc Nephrol 9: 1007-1014, 2014

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott A et al. Clin J Am Soc Nephrol 9: 1007-1014, 2014

Chronic Dialysis Among Survivors of Acute Kidney Injury Requiring Dialysis

Wald R et al. JAMA 2009, 302: 1179

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott A et al. Clin J Am Soc Nephrol 9: 1007-1014, 2014

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott A et al. Clin J Am Soc Nephrol 9: 1007-1014, 2014

Huang L et al. Kidney Blood Press Res 2019;44:879-896

Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired

Acute Kidney Injury: A Meta-Analysis

LoHS

Renalrecovery

Huang L et al. Kidney Blood Press Res 2019;44:879-896

Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired

Acute Kidney Injury: A Meta-Analysis

mortality

Huang L et al. Kidney Blood Press Res 2019;44:879-896

Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired

Acute Kidney Injury: A Meta-Analysis

What can we do?

Acute Kidney Injury in the Era of the AKI E-Alert

Holmes J et al. Clin J Am Soc Nephrol 11: 2123-2131, 2016

Acute Kidney Injury in the Era of the AKI E-Alert

Holmes J et al. Clin J Am Soc Nephrol 11: 2123-2131, 2016

Impact of Electronic AKI Alerts With Automated Nephrologist Consultation on Detection and

Severity of AKI

Park S et al. Am J Kidney Dis 71: 9-19, 2017

Impact of Electronic AKI Alerts With Automated Nephrologist Consultation on Detection and

Severity of AKI

Park S et al. Am J Kidney Dis 71: 9-19, 2017

Impact of Electronic AKI Alerts With Automated Nephrologist Consultation on Detection and

Severity of AKI

Park S et al. Am J Kidney Dis 71: 9-19, 2017

Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors

Harel Z et al. Kidney Int 83: 901–908, 2013

Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors

Harel Z et al. Kidney Int 83: 901–908, 2013

Thank you for your attention!