Physician Prevention of Acute Kidney Injury.
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.
Division Of Nephrology/Hypertension, Department Of Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill.
Hala
H
Yamout
Division Of Nephrology/Hypertension, Department Of Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill. Electronic address: m-levin@northwestern.edu.
Murray L
ML
Levin
Division Of Nephrology/Hypertension, Department Of Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill.
Robert M
RM
Rosa
Nephrology Associates of Northern Illinois and Indiana, Merrillville, Ind.
Kevin
K
Myrie
Sutter East Bay Medical Foundation, Berkeley, Calif.
Sara
S
Westergaard
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D010819:Physician's Role; D012189:Retrospective Studies; D055815:Young Adult
D003287:Contrast Media; D003404:Creatinine
Acute kidney injury; Contrast-induced nephropathy; Hypotension; Nephrotoxicity