Physician Prevention of Acute Kidney Injury

被引:14
作者
Yamout, Hala [1 ,2 ]
Levin, Murray L. [1 ,2 ]
Rosa, Robert M. [1 ,2 ]
Myrie, Kevin [3 ]
Westergaard, Sara [4 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Dept Med, Div Nephrol Hypertens, Highland Pk, IL 60035 USA
[2] NW Mem Hosp, Chicago, IL 60611 USA
[3] Nephrol Associates Northern Illinois & Indiana, Merrillville, IN USA
[4] Sutter East Bay Med Fdn, Berkeley, CA USA
关键词
Acute kidney injury; Contrast-induced nephropathy; Hypotension; Nephrotoxicity; ACUTE-RENAL-FAILURE; PROGNOSTIC IMPORTANCE; HOSPITALIZED-PATIENTS; OUTCOMES; DIALYSIS; DISEASE; RISK; MORTALITY; DIAGNOSIS; HYDRATION;
D O I
10.1016/j.amjmed.2015.04.017
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: The frequency of acute kidney injury has become substantially greater over the recent past. Acute kidney injury, moreover, is associated with increased mortality and morbidity over both the short and long term. Despite these facts, its therapy has not changed significantly for many decades. Currently, therefore, prevention is the only action that can reduce the frequency and consequences of acute kidney injury. METHODS: Charts of 492 patients were reviewed retrospectively for the presence of acute kidney injury based on creatinine elevation. One hundred seventy patients were found to have acute kidney injury defined as a sustained elevation of serum creatinine >= 0.3 mg/dL for 48 hours or more. An agent or event was determined to be responsible for renal injury if there was the defined increase in serum creatinine within 48 hours of exposure. Charts were reviewed to determine if the renal injury was preventable. RESULTS: Fifty-one cases were considered to be preventable. Of these, 16 had not received saline prophylaxis for intravenous contrast when appropriate, 15 were not treated appropriately for hemodynamic instability or for hypertension, 9 had inappropriate use of medications, and 11 received multiple nephrotoxic agents. CONCLUSIONS: In a retrospective analysis of 170 hospitalized patients who developed acute kidney injury during admission, 30% of episodes could have been avoided if physicians had taken appropriate preventive actions. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:1001 / 1006
页数:6
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