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AKI: New Name, New Focus

Tinker Ready, for HealthLeaders Media, August 13, 2014
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This article appears in the July/August 2014 issue of HealthLeaders magazine.

Acute kidney injury—the sudden decline of renal function—has been underdiagnosed and, in recent years, redefined and renamed. So it's no surprise the condition often goes undetected in hospital patients, with one study estimating that AKI is diagnosed in only 13% of those affected.

The often asymptomatic condition is treatable, but linked to long-term risk for chronic kidney disease and cardiovascular problems. The push is on now to prevent it and, when that fails, catch it and treat it early. The Centers for Medicare & Medicaid Services is moving toward adding a form of AKI linked to contrast agents to its list of complications it no longer covers. Hospitals are setting up programs to screen patients identified as being at risk for the condition.

Sometimes, awareness alone can bring change. When doctors at Cincinnati Children's Hospital Medical Center—which reported patient services revenue of $1.3 billion last year—flagged signs of AKI in a select group of patients from July 2011 to June 2012, the number of days it took those patients to recover dropped by 42%.

"We didn't tell anyone to do anything else but monitor kidney function," says Stuart L. Goldstein, MD, director of the hospital's Center for Acute Care Nephrology. "We didn't tell them to change doses of antibiotics. We didn't tell them to change the prescriptions that were being used. All we did was raise awareness and identify kids at risk. The pharmacists rounding with the healthcare teams were instrumental in identifying at-risk patients and recommending daily kidney function monitoring for them." The doctors took it on themselves to take action, he says.

Once considered the unavoidable consequence of useful drugs and diagnostics, AKI is being recast as preventable and treatable. Nephrologists say risk stratification and awareness programs, like the one at Cincinnati Children's, are key. By flagging and monitoring patients most likely to lose kidney function, researchers are finding new ways to get at the underdiagnosed condition.

It's a bad one. The National Kidney Foundation reports that AKI affects 20% of all hospitalized patients and more than 45% of patients in a critical care setting. AKI, by some counts, has a 50% mortality rate, according to a study published last year in Critical Care Research and Practice.

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