Early nephrologist involvement in Hospital-acquired acute kidney injury

A pilot study

Geetha Balasubramanian, Ziyad Al-Aly, Abdul Moiz, Michael Rauchman, Zhiwei Zhang, Rajalakshmi Gopalakrishnan, Sumitra Balasubramanian, Tarek Ashkar (El-Achkar)

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Background The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown. Study Design Prospective controlled nonrandomized intervention study. Setting & Participants We screened daily serum creatinine (SCr) levels of 4,296 patients admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 patients (8.2%) met the definition of in-hospital AKI (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 patients were enrolled in the control (standard care) and intervention groups, respectively. Intervention Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of AKI. Outcome Primary outcome defined as 2.5-fold increase in SCr level from admission. Measurement Daily SCr until discharge. Results The 2 groups had similar characteristics at baseline and at the time of AKI. The intervention was completed at a mean of 13.1 ± 0.8 hours from the onset of AKI. Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9% of patients in the control group compared with 3.3% of patients in the EARLI group (P = 0.02). Patients in the EARLI group had a lower peak SCr level of 1.8 ± 0.1 versus 2.1 ± 0.2 mg/dL in controls (P = 0.01). Limitations Single-center nonrandomized study of mostly US male veterans. Conclusions Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings.

Original languageEnglish (US)
Pages (from-to)228-234
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume57
Issue number2
DOIs
StatePublished - Feb 2011
Externally publishedYes

Fingerprint

Acute Kidney Injury
Creatinine
Nephrology
Kidney
Serum
Veterans
Referral and Consultation
Control Groups
Nephrologists
Prospective Studies

Keywords

  • Acute kidney injury
  • nephrology consultation

ASJC Scopus subject areas

  • Nephrology

Cite this

Early nephrologist involvement in Hospital-acquired acute kidney injury : A pilot study. / Balasubramanian, Geetha; Al-Aly, Ziyad; Moiz, Abdul; Rauchman, Michael; Zhang, Zhiwei; Gopalakrishnan, Rajalakshmi; Balasubramanian, Sumitra; Ashkar (El-Achkar), Tarek.

In: American Journal of Kidney Diseases, Vol. 57, No. 2, 02.2011, p. 228-234.

Research output: Contribution to journalArticle

Balasubramanian, G, Al-Aly, Z, Moiz, A, Rauchman, M, Zhang, Z, Gopalakrishnan, R, Balasubramanian, S & Ashkar (El-Achkar), T 2011, 'Early nephrologist involvement in Hospital-acquired acute kidney injury: A pilot study', American Journal of Kidney Diseases, vol. 57, no. 2, pp. 228-234. https://doi.org/10.1053/j.ajkd.2010.08.026
Balasubramanian G, Al-Aly Z, Moiz A, Rauchman M, Zhang Z, Gopalakrishnan R et al. Early nephrologist involvement in Hospital-acquired acute kidney injury: A pilot study. American Journal of Kidney Diseases. 2011 Feb;57(2):228-234. https://doi.org/10.1053/j.ajkd.2010.08.026
Balasubramanian, Geetha ; Al-Aly, Ziyad ; Moiz, Abdul ; Rauchman, Michael ; Zhang, Zhiwei ; Gopalakrishnan, Rajalakshmi ; Balasubramanian, Sumitra ; Ashkar (El-Achkar), Tarek. / Early nephrologist involvement in Hospital-acquired acute kidney injury : A pilot study. In: American Journal of Kidney Diseases. 2011 ; Vol. 57, No. 2. pp. 228-234.
@article{361b5b9c57624e2fbfb512822f58cdc3,
title = "Early nephrologist involvement in Hospital-acquired acute kidney injury: A pilot study",
abstract = "Background The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown. Study Design Prospective controlled nonrandomized intervention study. Setting & Participants We screened daily serum creatinine (SCr) levels of 4,296 patients admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 patients (8.2{\%}) met the definition of in-hospital AKI (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 patients were enrolled in the control (standard care) and intervention groups, respectively. Intervention Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of AKI. Outcome Primary outcome defined as 2.5-fold increase in SCr level from admission. Measurement Daily SCr until discharge. Results The 2 groups had similar characteristics at baseline and at the time of AKI. The intervention was completed at a mean of 13.1 ± 0.8 hours from the onset of AKI. Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9{\%} of patients in the control group compared with 3.3{\%} of patients in the EARLI group (P = 0.02). Patients in the EARLI group had a lower peak SCr level of 1.8 ± 0.1 versus 2.1 ± 0.2 mg/dL in controls (P = 0.01). Limitations Single-center nonrandomized study of mostly US male veterans. Conclusions Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings.",
keywords = "Acute kidney injury, nephrology consultation",
author = "Geetha Balasubramanian and Ziyad Al-Aly and Abdul Moiz and Michael Rauchman and Zhiwei Zhang and Rajalakshmi Gopalakrishnan and Sumitra Balasubramanian and {Ashkar (El-Achkar)}, Tarek",
year = "2011",
month = "2",
doi = "10.1053/j.ajkd.2010.08.026",
language = "English (US)",
volume = "57",
pages = "228--234",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Early nephrologist involvement in Hospital-acquired acute kidney injury

T2 - A pilot study

AU - Balasubramanian, Geetha

AU - Al-Aly, Ziyad

AU - Moiz, Abdul

AU - Rauchman, Michael

AU - Zhang, Zhiwei

AU - Gopalakrishnan, Rajalakshmi

AU - Balasubramanian, Sumitra

AU - Ashkar (El-Achkar), Tarek

PY - 2011/2

Y1 - 2011/2

N2 - Background The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown. Study Design Prospective controlled nonrandomized intervention study. Setting & Participants We screened daily serum creatinine (SCr) levels of 4,296 patients admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 patients (8.2%) met the definition of in-hospital AKI (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 patients were enrolled in the control (standard care) and intervention groups, respectively. Intervention Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of AKI. Outcome Primary outcome defined as 2.5-fold increase in SCr level from admission. Measurement Daily SCr until discharge. Results The 2 groups had similar characteristics at baseline and at the time of AKI. The intervention was completed at a mean of 13.1 ± 0.8 hours from the onset of AKI. Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9% of patients in the control group compared with 3.3% of patients in the EARLI group (P = 0.02). Patients in the EARLI group had a lower peak SCr level of 1.8 ± 0.1 versus 2.1 ± 0.2 mg/dL in controls (P = 0.01). Limitations Single-center nonrandomized study of mostly US male veterans. Conclusions Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings.

AB - Background The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown. Study Design Prospective controlled nonrandomized intervention study. Setting & Participants We screened daily serum creatinine (SCr) levels of 4,296 patients admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 patients (8.2%) met the definition of in-hospital AKI (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 patients were enrolled in the control (standard care) and intervention groups, respectively. Intervention Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of AKI. Outcome Primary outcome defined as 2.5-fold increase in SCr level from admission. Measurement Daily SCr until discharge. Results The 2 groups had similar characteristics at baseline and at the time of AKI. The intervention was completed at a mean of 13.1 ± 0.8 hours from the onset of AKI. Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9% of patients in the control group compared with 3.3% of patients in the EARLI group (P = 0.02). Patients in the EARLI group had a lower peak SCr level of 1.8 ± 0.1 versus 2.1 ± 0.2 mg/dL in controls (P = 0.01). Limitations Single-center nonrandomized study of mostly US male veterans. Conclusions Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings.

KW - Acute kidney injury

KW - nephrology consultation

UR - http://www.scopus.com/inward/record.url?scp=78751631543&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78751631543&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2010.08.026

DO - 10.1053/j.ajkd.2010.08.026

M3 - Article

VL - 57

SP - 228

EP - 234

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 2

ER -