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• W2087438037 abstract "Acute kidney injury (AKI) is increasingly prevalent in developing and developed countries and is associated with severe morbidity and mortality. Most etiologies of AKI can be prevented by interventions at the individual, community, regional, and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of AKI and provide guidance on preventive strategies, as well as early recognition and management. Efforts should be focused on minimizing causes of AKI, increasing awareness of the importance of serial measurements of serum creatinine in high-risk patients, and documenting urine volume in acutely ill people to achieve early diagnosis; there is as yet no definitive role for alternative biomarkers. Protocols need to be developed to systematically manage prerenal conditions and specific infections. More accurate data about the true incidence and clinical impact of AKI will help to raise the importance of the disease in the community, increase awareness of AKI by governments, the public, general and family physicians, and other health-care professionals to help prevent the disease. Prevention is the key to avoid the heavy burden of mortality and morbidity associated with AKI. Acute kidney injury (AKI) is increasingly prevalent in developing and developed countries and is associated with severe morbidity and mortality. Most etiologies of AKI can be prevented by interventions at the individual, community, regional, and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of AKI and provide guidance on preventive strategies, as well as early recognition and management. Efforts should be focused on minimizing causes of AKI, increasing awareness of the importance of serial measurements of serum creatinine in high-risk patients, and documenting urine volume in acutely ill people to achieve early diagnosis; there is as yet no definitive role for alternative biomarkers. Protocols need to be developed to systematically manage prerenal conditions and specific infections. More accurate data about the true incidence and clinical impact of AKI will help to raise the importance of the disease in the community, increase awareness of AKI by governments, the public, general and family physicians, and other health-care professionals to help prevent the disease. Prevention is the key to avoid the heavy burden of mortality and morbidity associated with AKI. On 14 March 2013, the 8th World Kidney Day (WKD) will be celebrated. WKD is an annual event jointly organized by the International Society of Nephrology and the International Federation of Kidney Foundations. This year, we aim to alert the public to the global increase in acute kidney injury (AKI) in both developing and developed countries. AKI is a syndrome of abrupt loss of kidney function, often with oliguria, which is strongly associated with increased early and long-term patient morbidity and mortality, as well as the subsequent development of chronic kidney disease (CKD). There is an urgent need for a global health strategy to reduce the enormous growing burden of AKI and its consequences. We advocate that efforts focused on preventing AKI be coupled with early detection and treatment, and adequate follow-up to reduce mortality and the long-term burden of AKI-induced CKD. The KDIGO (Kidney Disease Improving Global Outcome) Clinical Practice Guideline for AKI defines AKI as any of the following: increase in serum creatinine by ≥0.3mg/dl (≥26.5μmol/l) within 48hours, increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days, or urine volume <0.5ml/kg/h for 6h.1KDIGO Clinical practice guideline for acute kidney injury.Kidney Int. 2012; 2: 1-138Google Scholar An epidemiological study in Scotland showed that the incidence of AKI was 2147 per million population per year (pmp),2Ali T. Khan I. Simpson W. et al.Incidence and outcomes in acute kidney injury: a comprehensive population-based study.J Am Soc Nephrol. 2007; 18: 1292-1298Crossref PubMed Scopus (666) Google Scholar and in a community study in Northern California the annual incidence of non-dialysis-requiring and dialysis-requiring AKI were, respectively, 3841 and 244p.m.p.;3Hsu C.Y. McCulloch C.E. Fan D. et al.Community-based incidence of acute renal failure.Kidney Int. 2007; 72: 208-212Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar this incidence increased over time and was consistently higher in men and in the elderly.3Hsu C.Y. McCulloch C.E. Fan D. et al.Community-based incidence of acute renal failure.Kidney Int. 2007; 72: 208-212Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar Unfortunately, there are still no comprehensive studies on the incidence of AKI in the community in the developing world. Recent hospital studies in the developed world report AKI in 3.2–9.6% of admissions, with overall in-hospital mortality around 20%, and up to 50% in ICU patients.4Fang Y. Ding X. Zhong Y. et al.Acute kidney injury in a Chinese hospitalized population.Blood Purif. 2010; 30: 120-126Crossref PubMed Scopus (106) Google Scholar,5Lafrance J.P. Miller D.R. Acute kidney injury associates with increased long-term mortality.J Am Soc Nephrol. 2010; 21: 345-352Crossref PubMed Scopus (434) Google Scholar There is also increased long-term mortality in those with AKI surviving hospitalization, with adjusted mortality risk of 1.4, which augmented with increasing severity of AKI.5Lafrance J.P. Miller D.R. Acute kidney injury associates with increased long-term mortality.J Am Soc Nephrol. 2010; 21: 345-352Crossref PubMed Scopus (434) Google Scholar AKI requiring renal replacement therapy (RRT) occurs in 5–6% of ICU patients, with an extremely high in-hospital mortality rate of 60%.6Uchino S. Kellum J.A. Bellomo R. et al.Acute renal failure in critically ill patients: a multinational, multicenter study.JAMA. 2005; 294: 813-818Crossref PubMed Scopus (3162) Google Scholar It is estimated that about 2 million people die of AKI every year.6Uchino S. Kellum J.A. Bellomo R. et al.Acute renal failure in critically ill patients: a multinational, multicenter study.JAMA. 2005; 294: 813-818Crossref PubMed Scopus (3162) Google Scholar,7Murugan R. Kellum J.A. Acute kidney injury: what’s the prognosis?.Nat Rev Nephrol. 2011; 7: 209-217Crossref PubMed Scopus (309) Google Scholar Those who survive AKI have a higher risk for later development of CKD.8Coca S.G. Singanamala S. Parikh C.R. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis.Kidney Int. 2012; 81: 442-448Abstract Full Text Full Text PDF PubMed Scopus (1379) Google Scholar Eighty-six per cent of the world’s population lives in low- and middle-income countries, which have many contrasts and inequalities. Sophisticated tertiary hospitals coexist with inadequate primary care and poor health system infrastructure in the same country and even in the same city. In such countries, AKI has a peculiar bimodal presentation. In modern, large, urban centers, the pattern of AKI is very similar to that found in the developed world; it is predominantly a hospital-acquired disease occurring mostly in older, critically ill multiorgan failure patients with substantial comorbidity. The main cause for AKI in this population is renal ischemia, principally due to sepsis, and is often associated with nephrotoxic drugs.9Santos W.J. Zanetta D.M. Pires A.C. et al.Patients with ischaemic, mixed and nephrotoxic acute tubular necrosis in the intensive care unit - a homogeneous population?.Crit Care. 2006; 10: R68Crossref PubMed Scopus (64) Google Scholar At the same time, in rural areas or smaller cities in the countryside, AKI will usually be a community-acquired disease, affecting younger and previously healthy individuals. In this population, specific causes of AKI include diarrheal diseases with dehydration, infectious diseases (malaria, dengue, yellow-fever, leptospirosis, tetanus, and human immunodeficiency virus), animal venoms (snakes, bees, Loxosceles spiders, Lonomia caterpillars), septic abortion, dyes, and natural medicines.10Lombardi R. Yu L. Younes-Ibrahim M. et al.Epidemiology of acute kidney injury in Latin America.Semin Nephrol. 2008; 28: 320-329Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 11Naicker S. Aboud O. Gharbi M.B. Epidemiology of acute kidney injury in Africa.Semin Nephrol. 2008; 28: 348-353Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar, 12Jha V. Rathi M. Natural medicines causing acute kidney injury.Semin Nephrol. 2008; 28: 416-428Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar Most of these factors triggering AKI are associated with poverty and affect vulnerable populations because of poor sanitation and water hygiene (diarrheal diseases), a lack of education and access to an adequate urban infrastructure, and difficulty in having access to the health-care system (septic abortions, snakebite, natural medicines, tetanus) and breaking of an ecological balance from uncontrolled and unplanned urbanization (leptospirosis, yellow-fever, Africanized bees, and Lonomia caterpillar accidents).10Lombardi R. Yu L. Younes-Ibrahim M. et al.Epidemiology of acute kidney injury in Latin America.Semin Nephrol. 2008; 28: 320-329Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 11Naicker S. Aboud O. Gharbi M.B. Epidemiology of acute kidney injury in Africa.Semin Nephrol. 2008; 28: 348-353Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar, 12Jha V. Rathi M. Natural medicines causing acute kidney injury.Semin Nephrol. 2008; 28: 416-428Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar, 13Abdulkader R.C. Barbaro K.C. Barros E.J. et al.Nephrotoxicity of insect and spider venoms in Latin America.Semin Nephrol. 2008; 28: 373-382Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar In the developing world, the same ICU may have a typical bacterial sepsis–induced AKI patient side by side with a patient suffering from dengue or tetanus-induced AKI. Increasingly, these causes of AKI may be exported from developing to developed countries because of immigration, business travel, tourism, and world warming. The availability of standardized criteria for diagnosis and staging of AKI has made clear that the prevalence of AKI in the developed world has increased in the past decade.14Mehta R.L. Kellum J.A. Shah S.V. et al.Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.Crit Care. 2007; 11: R31Crossref PubMed Scopus (5241) Google Scholar,15Cruz D.N. Ricci Z. Ronco C. Clinical review: RIFLE and AKIN--time for reappraisal.Crit Care. 2009; 13: 211Crossref PubMed Scopus (191) Google Scholar AKI is now encountered in 45% of patients admitted to the ICU and 20% of hospitalized patients.16Bellomo R. Kellum J.A. Ronco C. Acute kidney injury.Lancet. 2012; 380: 756-766Abstract Full Text Full Text PDF PubMed Scopus (1069) Google Scholar,17Goldstein S.L. Acute kidney injury in children and its potential consequences in adulthood.Blood Purif. 2012; 33: 131-137Crossref PubMed Scopus (111) Google Scholar This increased prevalence likely reflects an aging population burdened by multiple comorbidities, which is often managed with multiple drugs.18Chronopoulos A. Cruz D.N. Ronco C. Hospital-acquired acute kidney injury in the elderly.Nat Rev Nephrol. 2010; 6: 141-149Crossref PubMed Scopus (79) Google Scholar,19Waikar S.S. Liu K.D. Chertow G.M. Diagnosis, epidemiology and outcomes of acute kidney injury.Clin J Am Soc Nephrol. 2008; 3: 844-861Crossref PubMed Scopus (387) Google Scholar AKI is a multifactorial entity. Etiological factors include prerenal injury contributing to reduced renal perfusion; however, the precipitating events are often iatrogenic, e.g., hypotension during anesthesia and surgery, or profound diarrhea secondary to C. difficile infection resulting from aggressive antibiotic therapy.20Cerda J. Lameire N. Eggers P. et al.Epidemiology of acute kidney injury.Clin J Am Soc Nephrol. 2008; 3: 881-886Crossref PubMed Scopus (194) Google Scholar Drug-induced kidney injury is recognized as a major factor in about 20% of cases, whereas hospital-acquired infections, sepsis, complex surgery, and diagnostic procedures requiring intravenous contrast continue to be significant risk factors for the development of AKI.21Perazella M.A. Drug use and nephrotoxicity in the intensive care unit.Kidney Int. 2012; 81: 1172-1178Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 22Zarjou A. Agarwal A. Sepsis and acute kidney injury.J Am Soc Nephrol. 2011; 22: 999-1006Crossref PubMed Scopus (396) Google Scholar, 23Solomon R. Dauerman H.L. Contrast-induced acute kidney injury.Circulation. 2010; 122: 2451-2455Crossref PubMed Scopus (184) Google Scholar Patients in the ICU are dying of AKI and not just simply with AKI. Experimental and small observational studies have shown that AKI negatively affects immunity and is associated with higher rates of infection.24Singbartl K. Kellum J.A. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes.Kidney Int. 2012; 81: 819-825Abstract Full Text Full Text PDF PubMed Scopus (339) Google Scholar AKI patients frequently develop a vicious cycle of immune dysfunction, sepsis, and multiorgan failure. Indeed, severe sepsis is currently the major cause of AKI in the United States.25NIDDKD N.I.H. Bethesda M.D. USRDS 2010 Annual Data Report.Atlas of CKD and ESRD in the United States. 2010Google Scholar The host response to sepsis involves an inflammatory response that activates innate immunity. If this persists, the immune response will lead to a release of a multitude of proinflammatory products, which frequently cause organ dysfunction, including kidney failure.26Gonçalves G.M. Zamboni D.S. Câmara N.O. The role of innate immunity in septic acute kidney injuries.Shock. 2010; 34: 22-26Crossref PubMed Scopus (61) Google Scholar A key issue in the developed world is that patients are increasingly cared for by multiple providers, often in different health-care systems, with infrequent or minimal data sharing between providers and across health-care systems. This lack of knowledge often results in overdosing of nephrotoxic medications, for example, a dentist might prescribe large doses of nonsteroidal anti-inflammatory drugs for pain management after dental surgery without the knowledge of a patient’s underlying CKD, thus contributing to development of AKI superimposed on the CKD. As kidney disease is generally silent, unless it is severe enough to reduce urine output or lead to complications, it can often go unrecognized.27Macedo E. Malhotra R. Bouchard J. et al.Oliguria is an early predictor of higher mortality in critically ill patients.Kidney Int. 2011; 80: 760-767Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar A recent national audit of the care provided to patients who died with a diagnosis of AKI in United Kingdom hospitals revealed several shortcomings. AKI was often diagnosed late in the course, the initial severity was underestimated, and diagnostic and therapeutic interventions were often incomplete or delayed.28MacLeod A. NCEPOD report on acute kidney injury- must do better.Lancet. 2009; 374: 1405-1406Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar This audit illustrates the urgent need for improving awareness of AKI and has prompted the medical community in the UK to implement specific measures to facilitate early recognition, timely diagnosis, and appropriate management and follow-up of AKI patients.29Prescott A.M. Lewington A. O’Donoghue D. Acute kidney injury: top ten tips.Clin Med. 2012; 12: 328-332Crossref PubMed Scopus (20) Google Scholar The epidemiology of pediatric AKI has shifted in the past decades from intrinsic kidney diseases such as hemolytic uremic syndrome and glomerulonephritis to ischemia, nephrotoxins, and sepsis in critically ill children.17Goldstein S.L. Acute kidney injury in children and its potential consequences in adulthood.Blood Purif. 2012; 33: 131-137Crossref PubMed Scopus (111) Google Scholar Estimates of the incidence of AKI in children vary depending on the definition used and the population assessed, but it is clearly increasing. A pediatric-modified RIFLE (risk, injury, failure, loss, and end-stage kidney) criterion was developed and validated in 2007. The major difference with the original RIFLE definition is the use of changes in estimated creatinine clearance calculated by Schwartz formula rather than serum creatinine, in view of the large variation in body mass in children.17Goldstein S.L. Acute kidney injury in children and its potential consequences in adulthood.Blood Purif. 2012; 33: 131-137Crossref PubMed Scopus (111) Google Scholar Development of AKI has been consistently demonstrated as an independent risk factor for death in children, from neonates to adolescents. Recently, the concept of ‘renal angina’ was proposed as a tool to the early identification of kidney injury together with early adoption of preventive measures in children at high risk for the development of AKI.30Basu R.K. Chawla L.S. Wheeler D.S. et al.Renal angina: an emerging paradigm to identify children at risk for acute kidney injury.Pediatr Nephrol. 2012; 27: 1067-1078Crossref PubMed Scopus (84) Google Scholar One of the strongest indicators of ‘renal angina’ and risk of further development of AKI in children is fluid overload.17Goldstein S.L. Acute kidney injury in children and its potential consequences in adulthood.Blood Purif. 2012; 33: 131-137Crossref PubMed Scopus (111) Google Scholar,30Basu R.K. Chawla L.S. Wheeler D.S. et al.Renal angina: an emerging paradigm to identify children at risk for acute kidney injury.Pediatr Nephrol. 2012; 27: 1067-1078Crossref PubMed Scopus (84) Google Scholar As in adults, AKI carries a significant risk for late development of CKD in surviving children.17Goldstein S.L. Acute kidney injury in children and its potential consequences in adulthood.Blood Purif. 2012; 33: 131-137Crossref PubMed Scopus (111) Google Scholar,31Mammen C. Al Abbas A. Skippen P. et al.Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study.Am J Kidney Dis. 2012; 59: 523-530Abstract Full Text Full Text PDF PubMed Scopus (377) Google Scholar Apart from the high mortality associated with AKI, there are other major consequences. Patients with AKI utilize more resources and have longer hospital lengths of stay partly because of the effect of AKI on other organ functions. For instance, AKI patients have more difficulty being weaned off ventilators.32Vieira J.M. Castro I. Curvello-Neto A. et al.Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients.Crit Care Med. 2007; 35: 184-191Crossref PubMed Scopus (168) Google Scholar AKI patients are more prone to fluid overload, with a resultant increase in mortality and impaired renal recovery.33Bouchard J. Soroko S.B. Chertow G.M. et al.Program to Improve Care in Acute Renal Disease (PICARD) Study Group. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury.Kidney Int. 2009; 76: 422-427Abstract Full Text Full Text PDF PubMed Scopus (778) Google Scholar When patients leave the hospital, they generally require prolonged recuperation often in skilled nursing facilities and may not recover kidney function.34Fischer M.J. Brimhall B.B. Parikh C.R. Uncomplicated acute renal failure and post-hospital care: a not so uncomplicated illness.Am J Nephrol. 2008; 28: 523-530Crossref PubMed Scopus (16) Google Scholar In a study of over 4000 type 2 diabetic patients in the Veterans Affairs health-care system in the USA, approximately half required one or more hospitalizations, and among those requiring hospitalization 29% experienced at least one episode of AKI.35Thakar C.V. Christianson A. Himmelfarb J. et al.Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus.Clin J Am Soc Nephrol. 2011; 6: 2567-2572Crossref PubMed Scopus (338) Google Scholar CKD is now recognized as a major noncommunicable disease, and data in the same study of type 2 diabetics showed that AKI was an important independent risk factor for stage 4 CKD (hazard ratio 3.56), with each AKI episode doubling that risk. There is other consistent and increasing evidence that AKI contributes to CKD development and may result in dialysis dependency.8Coca S.G. Singanamala S. Parikh C.R. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis.Kidney Int. 2012; 81: 442-448Abstract Full Text Full Text PDF PubMed Scopus (1379) Google Scholar,36Bydash J.R. Ishani A. Acute kidney injury and chronic kidney disease: a work in progress.Clin J Am Soc Nephrol. 2011; 6: 2555-2557Crossref PubMed Scopus (37) Google Scholar Collectively, these data demonstrate the high personal and community costs of an episode of AKI and stress the pressing need to address this problem in an effective way.37Li P.K. Chow K.M. Matsuo S. et al.Asian Chronic Kidney Disease (CKD) Best Practice Recommendations – Positional Statements for Early Detection of CKD from Asian Forum for CKD Initiatives (AFCKDI).Nephrology. 2011; 16: 633-641PubMed Google Scholar A central tenet of the WKD message since 2006 has been that ‘kidney disease is common, harmful, and treatable’. Similar to CKD, AKI is common, harmful, and treatable, and is also largely preventable. The heterogeneity of patients and the broad range of situations where AKI is encountered make it challenging to standardize an approach for evaluating and managing patients with this syndrome. The recent KDIGO guidelines for management of AKI provide a useful reference to assist clinicians for managing AKI; however, the successful implementation of guidelines and their application to individual patients can be slow and requires concerted efforts.1KDIGO Clinical practice guideline for acute kidney injury.Kidney Int. 2012; 2: 1-138Google Scholar,38Fliser D. Laville M. Covic A. et al.A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: definitions, conservative management and contrast-induced nephropathy.Nephrol Dial Transplant. 2012Google Scholar Prevention of AKI starts in the community with prompt assessment of those at risk, for example, in taking prompt action following effective evaluation of the severity of fluid depletion in acute diarrhea. Regular drug therapy can compound that risk, and the many older people taking nonsteroidal anti-inflammatory drugs or renin–angiotensin system blockers should be educated to discontinue them temporarily in the face of acute intercurrent illness, a so-called ‘medication holiday’. In the developed world, the growing adoption of electronic medical records provides several opportunities for managing patients through the continuum of outpatient and in-hospital care. Several studies have now shown that active surveillance for changes in creatinine can automate alerts to guide drug dosing and reduce the incidence of drug-induced kidney injury.39Cho A. Lee J.E. Yoon J.Y. et al.Effect of an electronic alert on risk of contrast-induced acute kidney injury in hospitalized patients undergoing computed tomography.Am J Kidney Dis. 2012; 60: 74-81Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar,40Cox Z.L. Nelsen C.L. Waitman L.R. et al.Effects of clinical decision support on initial dosing and monitoring of tobramycin and amikacin.Am J Health Syst Pharm. 2011; 68: 624-632Crossref PubMed Scopus (32) Google Scholar An ‘AKI sniffer system’ embedded in the electronic medical record to warn physicians of changing renal function has been shown to increase the number and timeliness of early therapeutic interventions.41Colpaert K. Hoste E.A. Steurbaut K. et al.Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class.Crit Care Med. 2012; 40: 1164-1170Crossref PubMed Scopus (174) Google Scholar The emerging field of kidney-specific biomarkers of damage will additionally offer opportunities to improve care.42Mehta R.L. Biomarker explorations in acute kidney injury: the journey continues.Kidney Int. 2011; 80: 332-334Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar Several studies have now shown the ability of various biomarkers alone or in combination to facilitate earlier diagnosis and improve differential diagnosis of AKI. However, biomarker-guided interventions have not as yet been shown to be of benefit,43Endre Z.H. Walker R.J. Pickering J.W. et al.Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial).Kidney Int. 2010; 77: 1020-1030Abstract Full Text Full Text PDF PubMed Scopus (212) Google Scholar and currently serum creatinine and urinary volume remain the clinical pointers to AKI diagnosis. Given advances in medical informatics, biomarker development and interpretation, and therapeutic interventions, it is now imperative that we leverage these advances to educate physicians and care providers about AKI and provide them with the tools to manage these patients timely and effectively. In the hospital setting, AKI preventive measures continue to be adequate hemodynamic control, hydration, hematocrit and oxygen profiling, and avoidance of nephrotoxic drugs; other preventive maneuvers should be implemented for particular diseases or conditions causing AKI. In the developing world, awareness of the specific infectious or venomous organisms in certain areas will allow environmental protection, vaccines, pharmacological prophylaxis, and early administration of anti-venom. Early and adequate anti-venom administration is a valuable preventive maneuver for snakebite and caterpillar venom–induced AKI, reducing its morbidity and lethality.10Lombardi R. Yu L. Younes-Ibrahim M. et al.Epidemiology of acute kidney injury in Latin America.Semin Nephrol. 2008; 28: 320-329Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar,13Abdulkader R.C. Barbaro K.C. Barros E.J. et al.Nephrotoxicity of insect and spider venoms in Latin America.Semin Nephrol. 2008; 28: 373-382Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Prompt diagnosis, timely hemodialysis, and adequate supportive therapy are associated with improved outcome in tropical infectious disease–associated AKI, such as leptospirosis and malaria.10Lombardi R. Yu L. Younes-Ibrahim M. et al.Epidemiology of acute kidney injury in Latin America.Semin Nephrol. 2008; 28: 320-329Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 44Andrade L. de Francesco Daher E. Seguro A.C. Leptospiral nephropathy.Semin Nephrol. 2008; 28: 383-394Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 45Cerdá J. Bagga A. Kher V. et al.The contrasting characteristics of acute kidney injury in developed and developing countries.Nat Clin Pract Nephrol. 2008; 4: 138-153Crossref PubMed Scopus (161) Google Scholar As always, the early diagnosis of AKI is the key to minimize further insults. Prevention for AKI is clearly the key to avoid the heavy burden of mortality and morbidity associated with this syndrome (Table 1), and this will only come about through increasing awareness of the true incidence and clinical impact of AKI among governments, the public, general and family physicians, and other health-care professionals. Most etiologies of AKI can be prevented by interventions at the individual, community, regional, and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of this illness and provide guidance on preventive strategies and for early recognition and management. Efforts should be focused on minimizing AKI causes, increasing awareness of the importance of serial measurements of serum creatinine in high-risk patients, and observing urinary volume to achieve early diagnosis. Protocols need to be developed to systematically manage prerenal conditions and specific infections.Table 1Strategies for preventing AKIGovernment Funding support for acute kidney injury (AKI) research in hospital and community on AKI incidence, outcome, and mortality Funding support for setting up AKI registries Recognition of natural hazards for AKI: water sanitation, flooding, venomous animals Recognition of AKI in common infections: malaria, dengue, leptospirosis, HIV, postinfectious hemolytic uremic syndrome Better obstetric care Collaboration with health-care professionals on educating the public about AKI preventionPublic Awareness of the potential problems of AKI and avoid unsupervised, indiscriminate, and long-term use of nephrotoxic drugs and natural substancesGeneral practitioners and physicians Awareness of patients at risk for AKI and situations contributing to AKI Awareness of prerenal causes of AKI and of the need for early and appropriate rehydration and hemodynamic optimization in hypovolemic patients Awareness of natural and man-made nephrotoxin, nephrotoxic drugs, herbs, and indigenous medicine Judicious use of nephrotoxic drugs and awareness of potential drug interactions Early recognition of AKI and early referral to nephrologistsNephrologists Establish and implement common AKI diagnostic criteria and definitions for prevention, treatment, and research Find new diagnostic tools including inexpensive technology and biomarkers for AKI diagnosis and monitoring Adapt renal replacement therapy to regional needs, technique, and resource availability Open table in a new tab When AKI patients require RRT, the current KDIGO recommendations are to deliver an effluent volume of 20–25ml/kg/h for continuous RRT or to deliver a Kt/V of 3.9 per week when using intermittent or extended RRT.1KDIGO Clinical practice guideline for acute kidney injury.Kidney Int. 2012; 2: 1-138Google Scholar This requires careful monitoring, as there is often a significant reduction in the dose delivered versus that prescribed.46Claure-Del Granado R. Macedo E. Chertow G.M. et al.Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis.Clin J Am Soc Nephrol. 2011; 6: 467-475Crossref PubMed Scopus (97) Google Scholar Peritoneal dialysis (PD) should also be considered for AKI, particularly in developing countries, because it is a simple, effective, safe, and relatively inexpensive form of RRT.47Ponce D. Berbel M.N. Regina de Goes C. et al.High-volume peritoneal dialysis in acute kidney injury: indications and limitations.Clin J Am Soc Nephrol. 2012; 7: 887-894Crossref PubMed Scopus (88) Google Scholar The technical simplicity of PD and the potential to reduce costs if consumables can be made locally present an opportunity to establish cost-effective programs for managing AKI, as has been shown in a recently established PD program for managing AKI in one of the poorest countries in Africa.48Kilonzo K.G. Ghosh S. Temu S.A. et al.Outcome of acute peritoneal dialysis in northern Tanzania.Perit Dial Int. 2012; 32: 261-266Crossref PubMed Scopus (57) Google Scholar The worldwide celebration of WKD 2013 provides an opportunity to share the message that AKI is indeed common, harmful, preventable, and treatable, and that protecting the kidneys from this lethal syndrome is an important health strategy for the patient and the community. The effective implementation of such strategies will only come when both the general public and the renal community work together to convince health authorities of the pressing need to do this. Government and health authorities must allocate resources to manage this problem both in the developed and developing world." @default.
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• W2087438037 date "2013-03-01" @default.
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• W2087438037 title "Acute kidney injury: global health alert" @default.
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