Kidney Week

Abstract: FR-OR025

Defining Kidney Dysfunction in the Community Setting: The ISN 0by25 Initiative

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention
  October 26, 2018 | Location: 1B, San Diego Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Macedo, Etienne, University of California San Diego Medical Center, La Jolla, California, United States

Etienne Macedo, MD, PhD, FASN

• Sharma, Sanjib Kumar, B.P.Koirala Institute of Health Sciences, Dharan, Nepal

Sanjib Kumar Sharma,

• Hemmila, Ulla, College of Medicine, Malawi, Kokemäki, Finland

Ulla Hemmila,

• Claure-Del Granado, Rolando, Hospital Obrero #2 Universidad Mayor de San Simon, Zona Sarco, Bolivia, Plurinational State of

Rolando Claure-Del Granado,

• Shah, Bhupendra, B.P.Koirala Institute of Health Sciences, Dharan, Nepal

Bhupendra Shah,

• Mzinganjira, Henry E., MOH , Blantyre, Malawi

Henry E. Mzinganjira,

• Cerda, Jorge, Capital District Renal Physicians, Albany, New York, United States

Jorge Cerda,

• Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil

Emmanuel A. Burdmann,

• Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

Michael V. Rocco,

• Mehta, Ravindra L., University of California San Diego Medical Center, La Jolla, California, United States

Ravindra L. Mehta,

Group or Team Name

• ISN 0by25

Background

Community-acquired acute kidney injury (AKI) is common, but often unrecognized in resource-constrained settings. Limited lab assessments and unavailable informationon the prior state of kidney health contribute to this lack of recognition. In this study, we evaluated the efficacy of point of care (POC) serum creatinine (sCr) and urine dipstick tests to identify patients with kidney dysfunction at presentation to community health centres (CHC) and emergency departments (ED), as part of the International Society of Nephrology (ISN) 0by25 Pilot Feasibility Project.

Methods

Patients (pts) presenting at CHC or ED with signs or symptoms associated with high/moderate risk of developing AKI underwent sCr POC test and urine dipstick. At enrollment, pts were classified as chronic kidney disease (CKD) based on prior history, proteinuria(>1+) and/or baseline sCr within 12 mos by estimated GFR (CKD-EPI equation)) <60 mL/min/1.73 m²; normal renal function (NRF) (no proteinuria and eGFR>75ml/min/1.73 m²); and Acute Kidney Disease (AKD) neither meeting criteria for CKD or NRF. AKI was confirmed within 7days by sCr increase or decrease of 0.3 mg/dl or 1.5x from the enrollment value. Pt outcomes: progression of AKI, need for RRT, hospitalization, mortality and renal functional recovery, were assessed at 7days and 1, 3 and 6 mos.

Results

3577pts were screened, 2101enrolled; 91%adults, 9%children. At enrollment, 9% were CKD and 66% AKD. At 7 days, 30% of pts fulfilled criteria for AKI: 67 from NRF (13%), AKD 470 (33%) and CKD 91 (46%). Overall mortality rate was 7.4% at 7 days and increased to 13% at 6 months. In comparison to NRF, AKD and CKD patients had higher mortality at 7 days and follow up, and the development of AKI trended for higher mortality in both AKD and CKD groups. Of 434 patients with 3 months sCr follow up, new onset CKD was encountered in 40(26%) of AKD and 54(33%) of AKI patients. Of patients dying from CKD and AKD groups, non-provision of dialysis occurred in 31 (11%).

Conclusion

Kidney dysfunction is common in CHC and is associated with adverse outcomes. POC tests can identify patients with AKD and CKD at increased risk for AKI, progression of CKD and mortality. Early implementation of targeted interventions may help improve outcomes.

Funding

• Private Foundation Support