Anja Haase-Fielitz1,2,3, Martin Ernst4, Franziska Lehmanski5, Julia Gleumes5, Gundwara Blödorn6, Anke Spura7, Bernt-Peter Robra7, Saban Elitok8, Annemarie Albert8,9, Christian Albert9,10, Christian Butter11,5, Michael Haase9,10. 1. Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland. a.haase-fielitz@immanuel.de. 2. Medizinische Hochschule Brandenburg (MHB) "Theodor Fontane", Neuruppin, Deutschland. a.haase-fielitz@immanuel.de. 3. Institut für Sozialmedizin und Gesundheitsökonomie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland. a.haase-fielitz@immanuel.de. 4. Klinik für Orthopädie und Unfallchirurgie, Ameos Klinikum Schönebeck, Schönebeck, Deutschland. 5. Medizinische Hochschule Brandenburg (MHB) "Theodor Fontane", Neuruppin, Deutschland. 6. Charité - Universitätsmedizin Berlin, Berlin, Deutschland. 7. Institut für Sozialmedizin und Gesundheitsökonomie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland. 8. Klinik für Nephrologie und Endokrinologie, Klinikum Ernst von Bergmann, Potsdam, Deutschland. 9. MVZ Diaverum Am Neuen Garten, Potsdam, Deutschland. 10. Medizinische Fakultät, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland. 11. Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland.
Abstract
BACKGROUND: Delayed diagnosis and undertherapy of acute-on-chronic kidney injury (AKI-on-CKD) may trigger multiple organ injury and worsen clinical outcome. OBJECTIVES: This study focused on description of in-hospital care and cross-sectoral information transmission of patients with AKI-on-CKD including subgroup analyses (under surgical vs. non-surgical and nephrology vs. non-nephrology care). MATERIALS AND METHODS: At a university clinic, we analysed clinical measures and documentation in patients with AKI-on-CKD. Cox regression was performed to identify independent risk factors for in-hospital-mortality and 180-day mortality. RESULTS: In 38 (25.3%) of 150 patients, progressing AKI-on-CKD was found. Nineteen patients (12.7%) received acute dialysis. Thirty patients (20.0%) died in hospital. Systemic hypotension (n = 76, 50.7%) and nephrotoxins (n = 26, 17.3%), both considered as causes for AKI-on-CKD, were treated in 36.8 and 19.2%, respectively, of affected patients. Fluid balance was documented in one third of patients. Nephrology referral was requested in 38 (25.3%) of patients (median 24.0 h after AKI-on-CKD start). Acute renal complications (n = 74, 49.3%) were an independent risk factor for in-hospital mortality (ExpB 6.5, p = 0.022) or 180-day mortality (ExpB 3.3, p = 0.034). Rarely, outpatient physicians were informed about AKI-on-CKD (n = 42, 28.0%) or renal function follow-up was recommended (n = 14, 11.7% of surviving patients). CONCLUSIONS: Care gaps in therapy and cross-sectoral information transmission in patients with AKI-on-CKD were identified.
BACKGROUND: Delayed diagnosis and undertherapy of acute-on-chronic kidney injury (AKI-on-CKD) may trigger multiple organ injury and worsen clinical outcome. OBJECTIVES: This study focused on description of in-hospital care and cross-sectoral information transmission of patients with AKI-on-CKD including subgroup analyses (under surgical vs. non-surgical and nephrology vs. non-nephrology care). MATERIALS AND METHODS: At a university clinic, we analysed clinical measures and documentation in patients with AKI-on-CKD. Cox regression was performed to identify independent risk factors for in-hospital-mortality and 180-day mortality. RESULTS: In 38 (25.3%) of 150 patients, progressing AKI-on-CKD was found. Nineteen patients (12.7%) received acute dialysis. Thirty patients (20.0%) died in hospital. Systemic hypotension (n = 76, 50.7%) and nephrotoxins (n = 26, 17.3%), both considered as causes for AKI-on-CKD, were treated in 36.8 and 19.2%, respectively, of affected patients. Fluid balance was documented in one third of patients. Nephrology referral was requested in 38 (25.3%) of patients (median 24.0 h after AKI-on-CKD start). Acute renal complications (n = 74, 49.3%) were an independent risk factor for in-hospital mortality (ExpB 6.5, p = 0.022) or 180-day mortality (ExpB 3.3, p = 0.034). Rarely, outpatient physicians were informed about AKI-on-CKD (n = 42, 28.0%) or renal function follow-up was recommended (n = 14, 11.7% of surviving patients). CONCLUSIONS: Care gaps in therapy and cross-sectoral information transmission in patients with AKI-on-CKD were identified.
Authors: Anja Haase-Fielitz; Saban Elitok; Martin Schostak; Martin Ernst; Berend Isermann; Christian Albert; Bernt-Peter Robra; Andreas Kribben; Michael Haase Journal: Dtsch Arztebl Int Date: 2020-04-24 Impact factor: 5.594
Authors: Christian Albert; Michael Haase; Annemarie Albert; Antonia Zapf; Rüdiger Christian Braun-Dullaeus; Anja Haase-Fielitz Journal: Ann Lab Med Date: 2020-08-25 Impact factor: 3.464