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Zaccaria Ricci, MD
Department of Cardiology, Cardiac Surgery, and Pediatric Cardiac Intensive Care Unit
Bambino Gesù Children’s Hospital, IRCCS
Piazza S. Onofrio 4
IT–00165 Rome (Italy)
E-Mail [email protected]
Ding X, Rosner MH, Ronco C (eds): Acute Kidney Injury – Basic Research and Clinical Practice. Contrib Nephrol. Basel, Karger, 2018, vol 193, pp 13–20 (DOI: 10.1159/000484959)
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Acute Kidney Injury Risk Assessment
Wuhua Jianga–e · Jiarui Xua–e · Bo Shena–e · Yimei Wanga–e · Jie Tenga–e · Xiaoqiang Dinga–e
aDepartment of Nephrology, Zhongshan Hospital, Fudan University, bShanghai Medical Center of Kidney Disease, cShanghai Institute of Kidney and Dialysis, dShanghai Key Laboratory of Kidney and Blood Purification, and eHemodialysis Quality Control Center of Shanghai, Shanghai, China
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Abstract
Acute kidney injury (AKI) is a common global health challenge, affecting patient morbidity adversely and resulting in an estimated 1.4 million deaths per year. Since the International Society of Nephrology proposed a goal of eliminating preventable deaths from AKI by 2025, implementation of this program remains far from optimistic not only because of the lack of resources but also because of the scarce data addressing the epidemiology and causes of AKI, especially in developing countries, the relative insufficient health care resources to diagnose and treat AKI, and the delayed awareness of the impact of AKI on patient outcomes. Therefore, quality measures of the AKI management are crucial to ensure a better outcome achieved with integrated resource.
© 2018 S. Karger AG, Basel
Introduction
Acute kidney injury (AKI) is defined by a rapid deterioration in kidney function resulting in reduced clearance of excess fluid, electrolytes and toxins. It is remarkably prevalent among hospitalized patients and is associated with adverse outcomes such as prolonged length of stay and increased mortality [1]. Previous studies reported AKI incidence ranges between 5 and 7% of hospitalized patients [2–4], and resulting in a 1.7–6.9-fold increased risk of hospital mortality [5]. Recent data suggest that AKI has consequences not only during the acute phase, but also in long-term phases, resulting in progressive chronic kidney disease [6] and end-stage kidney disease requiring dialysis or kidney transplantation [5, 7, 8].
Recognizing this, the International Society of Nephrology (ISN) set a goal of eliminating preventable or treatable death from AKI by 2025, the “0 by 25” initiative [9]. However, the implementation of this scheme requires full consideration of the quality measure throughout the AKI management, and risk assessment is the first stage.
Quality Measurement and AKI Risk Assessment
Quality and safety are factors that are increasingly becoming important to be fulfilled in medicine. However, a formalized pattern has been emphasized to implement and monitor measures to assess the quality and safety of care delivered to patients. Quality and safety are critical priorities in the care of critically ill patients. For patients with AKI, measures and outcomes associated with quality of care have been increasingly important. Priorities for improving quality of care incorporate many important aspects including risk assessment, early diagnosis, monitoring, and strategies for management. Some quality improvements have been reported focusing on AKI management [10, 11]. These have contributed to the development of a consensus diagnosis for AKI and clinical practice guidelines for AKI. However, recent literature showed that the quality of care received by patients with AKI remains poor in some underdeveloped countries [12], and this may increase morbidity and mortality associated with iatrogenic complications and suboptimal