Over 1,500
patients were identified following hospitalization for acute kidney injury and
were found to have a 150 percent greater risk of developing kidney disease in
the future. Targeting and treating these patients could help save the billions
of dollars the US healthcare would spend in the future to meet the
.
is a condition where the
kidneys are unable to filter waste from the blood unexpectedly. AKI can occur
at any age due to various causes and has complex symptoms. More than 200,000
patients in the US and around 13.3 million globally are affected by AKI every
year.
Progression of kidney disease, kidney failure, heart disease, death and a greater
likelihood of AKI recurrence are common in patients who recover.
Chronic kidney disease is diagnosed in around 20
percent of patients within three to five years.
Earlier studies have attributed an increase in
hospitalization, costs from $5.4 billion to $24 billion to AKI. The costs
for patients requiring
dialysis with AKI were $11,016 to $42,077 higher,
per hospitalization, than for those without AKI. An additional 3.2 days of
hospitalization was required in the case of AKI. While the costs were higher
than myocardial infarction and gastrointestinal bleeding, they were comparable
to pneumonia, stroke and
pancreatitis.
Proteinuria
and AKI
Excess
protein in the urine -
Proteinuria, is a crucial indicator of kidney
function that could indicate early kidney disease. An inexpensive, non-invasive
test, proteinuria, though used by clinicians in other settings, is not commonly
measured in patients after AKI occurrence.
"There should
be much more emphasis on the testing of proteinuria after AKI to identify high-risk
patients,"said Chi-yuan
Hsu, the lead author, Professor and Chief of Nephrology at UCSF. He added
further,
"This simple test carries important prognostic information not conveyed
by serum creatinine."
Emphasizing
on the importance of measuring proteinuria Hsu said,
"Too many providers rely on serum creatinine alone to assess the health
of the kidneys, but they should not be falsely assured by the latter. Having a
more complete picture of kidney health is necessary for proper clinical
decision-making."
Results of the Study
The findings
of the study appear in
JAMA Internal
Medicine. About 1,538 hospitalized adults, equal numbers of those with and
without AKI were studied in this decade long study. The research period was
between December 2009 and February 2015, which included an annual in-person
visit through November 2018 and semiannual phone contacts.
In the
average follow-up period of 4.7 years, kidney disease progression and
end-stage renal disease were diagnosed in 138
patients overall (9 percent) and 58 patients respectively. Among patients with AKI, 97 (12.6 percent)
had kidney disease progression.
A 1.5-times higher risk of disease progression
was identified in patients with proteinuria after three months. Improving Outcomes
One of the
four North American clinical centers that participated in the study was Kaiser
Permanente/UCSF. Hsu, who is the adjunct investigator at the Kaiser Permanente
Division of Research also mentioned that in addition to getting tested,
controlling blood pressure or taking medications
to reduce proteinuria may also help lessen adverse outcomes.
Hsu said,
"Most patients with acute kidney injury are
unaware of their condition, lack understanding of its natural history or
predisposing factors, and desire more information. However, few discharge
communications currently provided to these patients explain the condition or
provide recommendations for care, which is needed throughout the care
continuum."
Reference : - Simple test identifies patients at high risk for future dialysis or transplant - (https://www.ucsf.edu/news/2020/01/416506/simple-test-identifies-patients-high-risk-future-dialysis-or-transplant)
Source: Medindia
