ACUTE KIDNEY INJURY 7
Running head: ACUTE KIDNEY INJURY 1
Acute Kidney Injury
Name
Institution
Acute Kidney Injury
Severe kidney injury (AKI) that was previously known as acute kidney failure is characterized by a dysfunction of renal leading to increased excretion of nitrogen by-products, hydroelectrolytic as well as acid-base defects (Nie et al. , 2017). The disorder has a high prevalence among patients in hospital populations of roughly 4.9 percent to 7.2 percent (Yokota et al. , 2018). This is especially common in ICUs victims. It is unfortunate that regardless of the effort to mitigate the situation by investing on technical as well therapeutic advances, in the recent few decades, it is clear that the total mortality of individuals suffering from AKI is still high, going up to 80 % of those patients in intensive care units (Yokota et al. , 2018).
Studies show that several factors predispose a given patient towards progressing with acute kidney injury, which includes age, surgery, comorbidities as well as sepsis. Such diseases as systemic arterial hypertension, illnesses attributed to the heart, chronic renal defects, diabetes mellitus as well as neoplasis (Alabdan et al. , 2018). Upon all the risk factors listed, the critical emphasis is on age, as health advances within this factor have resulted in increased life expectancy and hence an increased need to care for the elderly population. However, the older population shows a high predisposition towards the AKI development, probably because of kidney senility else it could be the due presence of higher prevalence of comorbidities as well as medical interventions like the application of contrasts medications that can lead to triggering of AKI (Seung et al. , 2019).
PICOT Question
For older adults (P), when compared to younger adults (C), what are some of the risk factors for AKI (acute kidney injury) that can be modified (I) to assist in altering the risk of AKI positively (O) within the shortest period possible (T)?
Search Strategy
To get the most relevant sources, the keywords of the study questions were searched. The target group was also keyed in the search engine to give the correct database for analysis of the most fruitful data. Four articles were identified as the primary references. Secondary sources were also found that had relatively associated information to the research question. This study will examine and investigate the risk factors for acute kidney injury, AKI, among older adults as compared to that of younger adults and come up with methods or steps that ought to be taken so that the state can be modified to ensure reduced effects of the disorder within the shortest time possible in the society. To conduct the study, four articles concerning the defect were reviewed. The study thus determines the factors to be considered in a bid to harmonize the current situation among the affected population.
The Significance of the PICOT Question
The study is essential in that it reveals the correlation between risk factors and age on the patients affected by AKI disorders. The cause of acute kidney injury can happen for many different reasons. Complications of acute kidney failure can be very dangerous to the body. This study will thus help in determining the various issues associated with the increased instances of the defect within the society.
Four Article Critique
The following articles were taken into consideration while carrying out this research:
Cely, J. E., Mendoza, E. J., Olivares, C. R., Sepúlveda, O. J., Acosta, J. S., Barón, R. A.,
& Diaztagle, J. J. (2017). Incidence and risk factors for early acute kidney injury in nonsurgical patients: a cohort study. International Journal of Nephrology, 2017. DOI: https://doi.org/10.1155/2017/5241482
Introduction
From this article, it was highlighted that detecting AKI five days of arrival of a patient could help prevent the potentially fatal complications associated with it. Nevertheless, the article pointed out that epidemiological data are limited, particularly on nonsurgical patients.
Objective
The primary objective of this study as outlined was to establish the incidences as well as risk factors that are associated with the acute kidney injury within five days when the patient is hospitalized.
Method
In this study, the prospective cohort of the population of hospitalized patients within the various internal departments of medicine was the method that was applied.
Sampling
A sample population of 1208 patients was evaluated where 16 percent of the total 400 patients were seen to have developed early AKI. The risk factors that were associated with this situation were pre-hospital treatments using nephrotoxic drugs.
Analysis and Measurement
Analysis of the outcome of the data was as follows (2.21 representing 95 percent CI, 12-4.36 and the p = 0.022) was observed, while the chronic kidney disorder as seen in stages 3 through 5 was as tabulated (3.56 which meant 95 percent CI 1.55-8.18 and p < 0.003) as well as venous thromboembolism during the time they are admitted (5.05 OR which represented 95% CI 1.59–16.0 and also p < 0.006). The average time of stay in the hospital was perceived to be higher on the patients who showed early development of AKI.
Findings and Discussion
The article concluded by showing that the incidences of the patients of AKI among nonsurgical patients are similar to the global prevalence of AKI. As of stage 3 progressively, the present risk factor is CKD, as well as prehospital treatments in the application of nephrotoxic medicines, and also VTE during the admission time. EAKI is linked to a more extended hospital stay and an increase in mortality rate, plus a requirement of dialysis.
Strength and Weakness
This study provided rich information through analysis of data using various tools like STATA, a measure of dispersion and central tendency, Mann-Whitney U test used to measure the variables in the study as well as descriptive data. Through the various statistical methods, the study was able to present detailed information on the research. This enhanced the clarity of the deductions derived from this study.
However, the research design of this study was single centered. This limited it from being valid externally. The study never considers the behavior of the disorder in other nations where there could be possible variations. The other reasons could be variations in a healthcare setting as regions. There were also no data results that were presented to monitor the validity of the outcome as it was limited to only the hospitalization period. The study thus lacks critical data like the mortality rate, as they are unknown as provided in the article.
Jain, A., McDonald, H. I., Nitsch, D., Tomlinson, L., & Thomas, S. L. (2017). Risk factors
for developing acute kidney injury in older people with diabetes and community-acquired pneumonia: a population-based UK cohort study. BMC Nephrology, 18(1), 142. DOI: 10.1186/s12882-017-0566-x https://www.ncbi.nlm.nih.gov/pubmed/28460637
Introduction
As per the article, AKI is becoming popular among the aged population within society. The study also indicates that there is a paucity of data about the risk factors of AKI among the elderly living with diabetes as well as infections in the society.
Objective
The aim of this study was an evaluation of the risk factors attached to developing acute kidney injury among the aged patients in England, as well as if of the impact on the functioning of the kidney vary with age.
Method
The methods used, was based on retrospective cohort research on a population within seven years. Electronic health data were strictly kept on track from clinics to hospital statistics. Sampling
The sample population consisted of peoples infected by diabetes of over 65 years of age and above. The factors that were kept into considerations are the link amid demographics, co-morbidities, treatments, and medications, along with participants’ lifestyles factors that were explored within 28 days in a logistic regression model. The results of this study were as follows: the sample was comprised of 3471 participants where 298 of the patients were observed to develop subsequent AKI.
Analysis and Measurement
A multivariate analysis highlighted several independently associated issues with AKI. These were: male sex which resulted into the following statistics: a ratio of 1.56 representing 95 percent and a confidence interval of between 1.20 to 2.04, the next factor is hypertension, which showed a ratio of 1.36 that is 95 percent and confidence interval of 1.01 to 1.85, the other factor was insulin with a ratio of 2.27 which is 95 percent a with a confidence interval of 1. 27 to 4.05, proteinuria incidence indicated a ratio of 1.27, 95 percent and confidence interval of 0.98 to 1.63, and finally was low estimation rates of glomerular filtrate.
Finding and Discussion
This study concluded that risks acknowledged could significantly help in the detection of elevated risk factors related to AKI in primary care units as well as in hospitals. This could be valuable, especially in necessitate of imperative management of the patients at towering risk of this disorder. Steps to be put into practice include; through monitoring, as well as averting AKI linked to pneumonia.
Strength and Weakness
This is study had significant strength in that it was substantial cohort research. It also applied quality-assured data which was for a good duration of time (7 years). It was able to describe the factors that are related to AKI in such a sample population. They used a conceptual framework as well as independent assessment methods that made it easy to establish various associations of AKI with the risk factors. The study was significant in that it provided a potential general outcome of AKI with elderly patients having diabetes.
However, the study never presents reliable dataset on disease durations as well as type regarding diabetes. Also, the study used data that were collected on a routine basis. The typical nature of data made it difficult to assess, it on severe conditions of the CAP with the AKI. Other limitations include missing data of the participants as well as factors such as ethnicity, which greatly affected the results of the research as they were not measured leaving a void.
Kane-Gill, S. L., Sileanu, F. E., Murugan, R., Trietley, G. S., Handler, S. M., & Kellum, J.
- (2015). Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. American Journal of Kidney Diseases, 65 (6), 860-869. DOI: 0.1053/j.ajkd.2014.10.018 https://www.ncbi.nlm.nih.gov/pubmed/25488106
R E S E A R C H A R T I C L E Open Access
Risk factors for developing acute kidney
injury in older people with diabetes and
community-acquired pneumonia: a
population-based UK cohort study
Anu Jain
*
, Helen I. McDonald, Dorothea Nitsch, Laurie Tomlinson, and Sara L. Thomas
Abstract
Background: Acute kidney injury (AKI) is being increasingly recognized in aging populations. There is a paucity
of data about AKI risk factors among older individuals with diabetes and infections, who are at particularly high risk
Of AKI. The objective of this study was to evaluate the risk factors for developing acute kidney injury (AKI) amongst
older patients with diabetes and community-acquired pneumonia (CAP) in England, and whether the impact of
underlying kidney function varied with age.
Methods: This was a population-based retrospective cohort study over seven years (01/04/2004–31/3/2011) using electronic
health records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. The study
population comprised of individuals with diabetes aged ≥65 years with CAP. Associations between demographic,
lifestyle factors, co-morbidities and medications and development of AKI within 28 days of CAP were explored
in a logistic regression model.
Results: Among 3471 patients with CAP and complete covariate data, 298 patients developed subsequent AKI. In
multivariable analyses, factors found to be independently associated with AKI included: male sex (adjusted odds ratio,
aOR: 1.56 95% confidence interval (CI): 1.20–2.04), hypertension (aOR1.36 95% CI 1.01–1.85), being prescribed either
angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor-blockers (aOR: 1.59 95% CI: 1.19–2.13), or insulin
(aOR: 2.27 95% CI: 1.27–4.05), the presence of proteinuria (aOR 1.27 95% CI 0.98–1.63), and low estimated glomerular
filtration rate (eGFR). The odds of AKI were more graded amongst older participants aged ≥80 years compared to
those of younger age: for eGFR of ≤29 mL/min/1.73m
2
(vs 60 ml/min/1.73m
2
) are: 5.51 95% CI 3.28–9.27 and for
eGFR 30–59 mL/min/1.73m
2
1.96 95% CI 1.30–2.96, whilst any eGFR < 60 ml/min/1.73m
2
was associated with
approximately 3-fold increase in the odds of AKI amongst younger individuals (p-value for interaction = 0.007).
Conclusions: The identified risk factors should help primary care, and hospital providers identify high risk patients
in need of urgent management including more intensive monitoring and prevention of AKI following pneumonia
Introduction
According to this article, risks that are associated with AKI among the old is yet to be examined appropriately and has been left out for long. The study thus sought to delineate the factors determining the risk factor coined to AKI among the older people in comparison to the younger adults.
Method
The study design that was employed in the facilitation of the research was a retrospective analysis of hospitalized patients that took place in the period between the year 2000 in July to 2008 in September.
Sampling
A sample population of 45 655 patients was applied in the study were all adults patients who within that duration were admitted to the care unit were identified. In the sampling, the patients that were to receive dialysis that kidney transplant was excluded in the analysis. Also, to be excluded were patients that had a baseline creatine level of over 4mg/deal, plus liver transplants, as well as patients with unknown age and also indeterminate AKI status thus leaving out a patient population of 39, 938.
Discussion
The predictors of the study; data collected was based on a multi-susceptibilities as well as different exposures which included age, gender, race, comorbidities, body mass, the condition of the disease, sepsis, as well as shock and kidney functioning baseline. The outcomes in this research were defined according to the improvement made on global findings of kidney diseases which were conducted across the age strata to determine their impact on the AKI development. The measurements were based on AUC in the prediction of acute kidney injury across all the present age groups.
Analysis and Measurement
The result of the study indicated 25, 230 which represented 63 percent of the total patients in the sample were 55 years of age and above. Overall, a population of 25,120 participants that is 62.9 percent developed AKI highlighting that in this, 69.2 percent of people were in the bracket of 55 years and above. It was shown that individuals of above 75 years faced a risk factor of drugs such as vancomycin as well as aminoglycosides together with nonsteroidal anti-inflammatories. The analysis of hypertension history; a ratio of 1.13 that is 95 percent with a confidence interval of 1.02 to 1.25, while that of sepsis had a ratio of 2.12 and 95 percent and certain interval of 1.68 to 2.67. With increased age, few variables predicted AKI, while patients model of the older participants turned to be less predictive showing p<0.001. The results of ages through 18-54, 55-64, 65-74 as well as 75 and over AUCs that represented 0.744 which was 95 percent and a CI of between 0.735 to 0.752, ratio 0.714 that is 95 percent and CI of 0.702 to 0.726, a ratio of 0.706 which is 95 percent with CI 0.693 to 0.718 and ratio 0673 ; 95 percent and CI of 0.661 to 0.685, respectively.
Finding and Exclusion
The conclusion of this research showed that possibilities of developing AKI are evidenced by an increase in age, though, variables that were used tended to be less prognostic for the disorder as the age increases. The research ends by commenting that efforts towards quantifying probable risk factors leading to the development of AKI could be hard to achieve especially on the old.
Strength and Weaknesses
In this study, data that was collected was for multiple susceptibilities as well as exposures. These include gender, age, body mass(BMI), sepsis, the severity of the disease, race, shock as well as comorbid conditions. This made the study more successful in that data was examined across age strata basin on its impact on AKI development. The use of AUC in predicting AKI across age groups on global perspectives made this study more reliable.
The limitation of this study was that the analysis might not apply to non-intensive patients that were with the care unit.
Lee, E. J., Jang, H. N., Cho, H. S., Bae, E., Lee, T. W., Chang, S. H., & Park, D. J. (2018).
The incidence, risk factors, and clinical outcomes of acute kidney injury (staged using the RIFLE classification) associated with intravenous acyclovir administration. Renal Failure, 40(1), 687-692. https://www.ncbi.nlm.nih.gov/pubmed/30741619
Introduction
According to this article, the study conducted highlights that Intravenous (IV) acyclovir, as a commonly administered treatment meant for infections that are viral which is well versed due to its nephrotoxicity. Nevertheless, this research shows that there is no known study for incidences, risk factors as well as clinical analysis of AKI that are associated administration of Intravenous acyclovir.
Method and Sampling
The method that was put into practice was a retrospective review of medical data comprising of a sample population of 287 participants (patients) who were admitted for intravenous acyclovir in the duration between 2008 in January to 2013 in May in Gyeongsang National University Hospital. Factors that were taken into consideration include demographic, risk factors, lab results, as well as concomitant drugs. The final of the study was derived from the medical data and was analyzed. The results showed that 51 which represented 17.8 percent of the sample population had AKI.
Analysis and Measurements
Regarding RIFLE categorization, the renal injury happened to be grouped as either in risk of dysfunction, which was 62.7 percent, renal injury at a percentage of 15.6 and finally renal failure at a percentage ratio of 21.6. In this research, no significant variations in age, gender, dosage, medication period, as well as the presence of hydration amid AKI as well as non-AKI patients. Nevertheless, systolic pressure observed on diabetes, concomitant vancomycin, as well as NSAIDs use, indicated a positive correlation with AKI development (where p= 0.04 and p < 0.001, then 0.01 again, and 0.04 in that order). In the sample population 2 of the participants, patients were treated with hemodialysis who ended up dying. From the findings, a high mortality rate was shown among patients with AKI, i.e. (p< 0.001). A multivariable analysis indicated that the presence of diabetes NSAIDs as well as of vancomycin fell under independent risk factors of intravenous IV associated to AKI as seen in the statistical analysis p-value of 0.001, confidence interval of 1.708-7.6330, p-value of 0.050, confidence interval of 1.000-6.917, and finally p-value 0.009, confidence interval 1.452-13.022, respectively.
Findings and Discussion
The study concluded by showing that AKI common among patients suffering from acyclovir IV. The research thus presses that physicians need to make an effort to prevent, as well as detect, plus manage acyclovir associated AKI in patients.
Strength and Weaknesses
The study applied RIFFLE system which useful in the staging of AKI. The lab data that were collected in this research was of high quality in that the participants were hospitalized. Also, all the assays presented were performed from the same laboratory. The collection of demographic data made the study outcome more reliable and accurate. The sample population used in the had a well laid extensive medical history, which made the results useful and successful. The study too excluded information of some patients whose laboratory test missed a follow up thus affecting the final research results.
Some of the limitations of the study were retrospective nature, hence the possibility to compromise the accuracy of the data since it all relied on medical information records. The study was not able to point out other possible causes of acute kidney injury (AKI). The other was that the study lacked a routine record of data on urine; hence incidences, as well as the severity condition of AKI, could have been estimated. And lastly, the research was single centered lacking external validity.
The Implication of the Study
The result from the analysis of the data as it is in articles review, implied that AKI increases with increase in age. This shows that to improve the lives of the aged, appropriate measures need to be undertaking concerning AKI. Various research should thus be conducted to come up with a clear correlation between the age and the risk factors leading to the development of the AKI defect.
Discussion and Synthesis of the Evidence
The method that was applied to conclude was an analysis of already conducted research paper. Data used within the articles and the results of its report were used to achieve the objective of the research study. Thus the reviews helped to establish the factors that are associated with AKI regarding age. The previously done researches were helpful in the establishment of the correlation between the risk factors and AKI.
Among the four articles or studies that were referenced, it was deduced that the predictors of the study, according to various data that was collected was based on a multi-susceptibilities and different exposures which included age, gender, race, comorbidities, body mass, the condition of the disease, sepsis, as well as shock and kidney functioning baseline. The risks that established from the various researches that were studied could be applied to examine and identify the multiple risks linked to the AKI and hence reduction of unnecessary deaths thus increase life expectancy.
The articles analyzed recommend that advanced research is taken on the AKI and its association to age factor. This would help solve the current situation and thus longer life among the aged who are affected by the disorder. It will also help minimize death occurring due to failure to the right medication among the victims of Aki.
The comparison was fruitful and was an excellent way to detect the situation of the aged population affected by acute kidney injury. However, advanced research should be taken to come up with a device method that can clearly show the correlation between age and the risk factor of AKI development. More research will help answer the questions yet to be clear on the matters of AKI within the society.
The major limitation of the studies reviewed was that the studies were single centered, missing of data, an inadequacy of collected information, thus lacking a well-designed and randomized prospective research study. This made it difficult to come up with a conventional or universal standard reasoning behind the risk factors of the AKI and their correlation. Physicians should, therefore, organize global research that will provide conventionally accepted outcomes on this defect. This will help get a genuine answer to the research question of our case of the AKI with the age factor.
Exclusion of various data in almost every research in the reviewed articles made it difficult to come up with an explicit finding. The reliability of the outcomes was thus at certain extents not convincing. Several flaws which led to the omission of particular information could have given room to assumption and hence compromising the results of the studies.
The findings of the review of the four articles in this research showed that chances of getting AKI to increase with a proportionate increase in an individual’s age. However, from the results analyzed from the reports or the four different studies, the present variables revealed a less possibility of the defect due to an increase in age. Last but not least it was observed that the urge to quantify the probable risk factors leading to the development of AKI might somewhat tricky in the elderly group.
Future studies need to be based on global perspectives other than a specific setting. All factors need to be taken into consideration for clarity and reliability and hence the validity of the results. Evidence-based research should thus be performed to solve the current situation of AKI and accordingly increase the mortality rate. The several limitations and weaknesses observed from the previous studies should be taken into consideration for improvements of the future researches. This would lead to improved results and more clear finding of the present situation thus promoting life.
References
Alabdan, N., Elfadol, A. H., Bustami, R., Al-Rajhi, Y. A., & Al-Sayyari, A. A. (2018).
Awareness of acute kidney injury risk factors and perspectives on its practice guidelines. Hospital Practice, 1-7. DOI: 10.1080/21548331.2018.1462081.
Cely, J. E., Mendoza, E. J., Olivares, C. R., Sepúlveda, O. J., Acosta, J. S., Barón, R. A.,
& Diaztagle, J. J. (2017). Incidence and risk factors for early acute kidney injury in nonsurgical patients: a cohort study. International Journal of Nephrology, 2017. DOI: https://doi.org/10.1155/2017/5241482
Kane-Gill, S. L., Sileanu, F. E., Murugan, R., Trietley, G. S., Handler, S. M., & Kellum, J.
- (2015). Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. American Journal of Kidney Diseases, 65 (6), 860-869. DOI: 0.1053/j.ajkd.2014.10.018 https://www.ncbi.nlm.nih.gov/pubmed/25488106
Jain, A., McDonald, H. I., Nitsch, D., Tomlinson, L., & Thomas, S. L. (2017). Risk factors
for developing acute kidney injury in older people with diabetes and community-acquired pneumonia: a population-based UK cohort study. BMC Nephrology, 18(1), 142. DOI: 10.1186/s12882-017-0566-x https://www.ncbi.nlm.nih.gov/pubmed/28460637
Lee, E. J., Jang, H. N., Cho, H. S., Bae, E., Lee, T. W., Chang, S. H., & Park, D. J. (2018).
The incidence, risk factors, and clinical outcomes of acute kidney injury (staged using the RIFLE classification) associated with intravenous acyclovir administration. Renal Failure, 40(1), 687-692. https://www.ncbi.nlm.nih.gov/pubmed/30741619
Nie, S., Tang, L., Zhang, W., Feng, Z., & Chen, X. (2017). Are there modifiable risk factors to
improve AKI?. BioMed Research International, 2017. DOI: https://doi.org/10.1155/2017/5605634.
Seung Don Baek, So Mi Ki , Jae-Young Kang, Minkyu Han, Eun Kyoung Lee, & Jai Won
Chang. (2019). A risk scoring model to predict renal progression associated with postcontrast acute kidney injury in chronic kidney disease patients. International Journal of Nephrology and Renovascular Disease.
Yokota, L. G., Sampaio, B. M., Rocha, E. P., Balbi, A. L., Prado, I. R. S., & Ponce, D. (2018).
Acute kidney injury in elderly patients: Narrative review on incidence, risk factors, and mortality. International Journal of Nephrology and Renovascular Disease, 11, 217-224. Retrieved 7th February 2018, from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097506/pdf/ijnrd-11-217.pd