Hi
I am evaluating renal recovery pattern among non-dialysis dependent AKI patients especially among patients with AKIN-I and AKIN-II stage of AKI. I am bit confuse because my outcome is renal recovery but available literature has vast variation for definition of renal recovery.
Most of the studies have been done on critically ill patients requiring dialysis. But in my case, patients have mild to moderate severity of AKI. There is no patient with dialysis in my study. So definition of dialysis independence will be excluded. On the other hand, as in my study patients are not critically ill and have less severe stage of AKI, so defining AKI as +/-25% of baseline will show that all patients have full recovery. However, most of the patients have elevated levels of Serum creatinine as compared to baseline. and I am confuse to declare them as fully renal recovery patients because I can not ignore the findings of previous studies that "small increase in serum creatinine is associated with high morbidity and mortality"
Please guide me in this regard, with appropriate reference
Epidemiology of renal recovery after acute renal failure.
Bagshaw SM1.
Abstract
PURPOSE OF REVIEW:
Recovery of renal function after acute renal failure is an important clinical determinant of patient morbidity. Herein, the epidemiology of renal recovery after acute renal failure will be described, along with potential predictive factors and interventions.
RECENT FINDINGS:
Renal recovery has been variably defined, most often as recovery to independence from renal replacement therapy. A recent consensus definition for acute renal failure has been published and included provisions for defining renal recovery. Renal recovery to renal replacement therapy independence occurs in the majority by hospital discharge and peaks by 90 days. All of older age, female sex, co-morbid illnesses, especially chronic kidney disease, and late initiation of renal replacement therapy or conventional intermittent renal replacement therapy have been coupled with non-recovery. Analysis of the literature suggests several interventions may influence recovery.
SUMMARY:
The prognosis is generally good for recovery after acute renal failure. Most patients will be independent of renal replacement therapy by 90 days. Additional research is necessary, however, to understand recovery rates not only to independence from renal replacement therapy, but also to complete and partial recovery. Future studies need to consider the health economic implications for survival and non-recovery. Finally, questions on the role of various interventions require characterization in randomized controlled trials to determine how they may influence renal prognosis.
http://www.ncbi.nlm.nih.gov/pubmed/17077684
Recovery process in patients followed-up due to acute kidney injury
K Magden,1 I Yildirim,1 ME Kutu,2 MC Ozdemir,2 S Peynir,2 A Altas,2 G Yildiz,3 and E Hur1
Abstract
Introduction: Acute kidney injury (AKI) may result in complete recovery in some of the patients and partial recovery in others. AKI episodes may accelerate the progression to chronic kidney disease and end-stage renal failure, while risk for morbidity and mortality is high following AKI. Discharge of patients from the hospital, independently from dialysis is a crucial outcome. Many patients without a need for dialysis, require follow-up for various durations and different treatments. The objective of this study was to compare mean recovery time of the patients followed-up due to prerenal, renal and postrenal AKIs.
Method: In this prospective observational study, a total of 159 patients hospitalized in Bulent Ecevit Hospital, clinic of nephrology or monitored in the other wards and intensive care unit due to AKI, between June 2011 and January 2012, were enrolled. The cases were divided into three groups as prerenal, renal and postrenal, and monitored with the daily visits and renal function testing.
Results: Prerenal AKI was seen by 54%, while renal AKI was observed by 34% and post-renal AKI by 12%. Incidence of chronic kidney disease was 17.6%. Totally 43 patients required hemodialysis (27%). Of these patients, 23 were in the prerenal AKI (53.4%), 15 in the renal AKI (34.8%) and 5 (11.6%) in the postrenal AKI group. Blood urea nitrogen (BUN) and creatinine levels were dropped to the basal values only in the prerenal AKI group, on the seventh day of treatment. These levels remained higher in the postrenal and renal groups on the 7th day of treatment compared to the basal values. BUN levels decreased to the normal values on average 7th day in the postrenal, while remained higher in the renal group.
Conclusion: Prerenal AKI patients recovered in seven days with a proper treatment, although AKI patients due to other reasons should be followed-up for a longer time.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872460/
Full renal recovery is complete recovery of renal function after acute renal insufficiency after 6 months. Partial renal recovery is only partial recovery of renal function after acute renal insufficiency or an acute deteriation after 6 months, and non-renal recovery is no recovery after 6 months. Note that in some cases there may be further recovery after more than 6 months.
In AKI , if creatinine returns to normal , it is full recovery ; if it declines partially , it is partial recovery & if it does not decline , it is difficult to decide & time should be given for 8 weeks to decide , whether it is reversible or not . The problem is to decide what the basic creatinine level is . It is essential to check the old records for the baseline creatinine . The KDIGO AKI guidelines has suggested the baseline normal creatinine ( if patient data of previous normal levels are not available ) as 0.8 mg/dl in elderly females ; 1.0 mg in young females & elderly males & 1.3 mg in young males ( if baseline figures are not available ) .
In ICU , mortality in patients depends on multi organ failure & patients can die with stage 1 & 2 AKI due to other factors . AKI is a marker of severity & patients may not survive to show reversibility in renal function .
In your study , if serum creatinine is above baseline , it suggests that complete recovery has not occurred . Please give your data of AKI for me understand your problem .
The question is that the concept of renal recovery may change, depending on how strict you are defining renal function. For example, criteria could be more strict in a clinical trial if defined by nephrologists. We are not comfortable with defining renal function only by plasma creatinine, at least from a subacute or chronic point of view.
Renal recovery following acute kidney injury.
Macedo E1, Bouchard J, Mehta RL.
Abstract
PURPOSE OF REVIEW:
Renal recovery after acute kidney injury (AKI) is an important outcome, most commonly defined as dialysis independence at hospital discharge. This review focuses on the epidemiology of renal recovery after AKI and provides a framework for determining the relationship of a lack of renal recovery and subsequent outcomes including the development of chronic kidney disease.
RECENT FINDINGS:
The majority of studies addressing renal recovery includes only critically ill patients requiring dialysis and considers renal recovery as dialysis independency at hospital discharge. However, a significant proportion of AKI patients are not in the ICU, are not dialyzed, and may require alternate definitions for assessing renal recovery. There is emerging evidence that an AKI episode can lead to chronic kidney disease and can accelerate the progression to end stage renal disease. Patients that survive after AKI present a higher long-term mortality risk, especially those with partial renal recovery.
SUMMARY:
Patients with incomplete renal recovery after AKI are underrepresented in most epidemiologic studies and the precise effect on the incidence and prevalence of end stage renal disease population has yet to be determined. A standardized definition for renal recovery is needed and the influence of an AKI episode on long-term outcomes needs to be better evaluated.
http://www.ncbi.nlm.nih.gov/pubmed/19005306
Thank You so much to all of you for your time and suggestions. i will definitely consider these suggestions.
Hi
I hope that following article will help you.
Regards
Article Recovery of kidney function following prolonged acute renal failure