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Neumayr TM, Bayrakci B, Chanchlani R, Deep A, Morgan J, Arikan AA, Basu RK, Goldstein SL, Askenazi DJ. Programs and processes for advancing pediatric acute kidney support therapy in hospitalized and critically ill children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference. Pediatr Nephrol 2024; 39:993-1004. [PMID: 37930418 PMCID: PMC10817827 DOI: 10.1007/s00467-023-06186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
Pediatric acute kidney support therapy (paKST) programs aim to reliably provide safe, effective, and timely extracorporeal supportive care for acutely and critically ill pediatric patients with acute kidney injury (AKI), fluid and electrolyte derangements, and/or toxin accumulation with a goal of improving both hospital-based and lifelong outcomes. Little is known about optimal ways to configure paKST teams and programs, pediatric-specific aspects of delivering high-quality paKST, strategies for transitioning from acute continuous modes of paKST to facilitate rehabilitation, or providing effective short- and long-term follow-up. As part of the 26th Acute Disease Quality Initiative Conference, the first to focus on a pediatric population, we summarize here the current state of knowledge in paKST programs and technology, identify key knowledge gaps in the field, and propose a framework for current best practices and future research in paKST.
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Affiliation(s)
- Tara M Neumayr
- Department of Pediatrics, Divisions of Pediatric Critical Care Medicine and Pediatric Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Benan Bayrakci
- Department of Pediatric Intensive Care Medicine, The Center for Life Support Practice and Research, Hacettepe University, Ankara, Türkiye
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Akash Deep
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
- Pediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK.
| | - Jolyn Morgan
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ayse Akcan Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Rajit K Basu
- Department of Pediatrics, Division of Critical Care Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Stuart L Goldstein
- Department of Pediatrics, Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David J Askenazi
- Department of Pediatrics, Division of Pediatric Nephrology, Pediatric and Infant Center for Acute Nephrology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
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Opgenorth D, Reil E, Lau V, Fraser N, Zuege D, Wang X, Bagshaw SM, Rewa O. Improving the quality of the performance and delivery of continuous renal replacement therapy (CRRT) to critically ill patients across a healthcare system: QUALITY CRRT: a study protocol. BMJ Open 2022; 12:e054583. [PMID: 35121604 PMCID: PMC8819828 DOI: 10.1136/bmjopen-2021-054583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Continuous renal replacement therapy (CRRT) is a continuous form of dialysis used to support critically ill patients with acute kidney injury. The ideal delivery of CRRT requires ongoing monitoring and reporting to adjust practice and deliver optimal therapy. However, this practice occurs variably. METHODS QUALITY CRRT is a multicentre, prospective, stepped-wedged, interrupted time series (ITS) evaluation of the effectiveness, safety and cost of implementing a multifaceted CRRT quality assurance and improvement programme across an entire healthcare system. This study will focus on the standardisation of CRRT programmes with similar structure, process and outcome metrics by the reporting of CRRT key performance indicators (KPIs). The primary outcome will be the quarterly performance of CRRT KPIs. Secondary outcomes will include patient-centred outcomes and economic outcomes. Analysis will compare pre-implementation and post-implementation groups as well as for the performance of KPIs using an ITS methodology. The health economic evaluation will include a within-study analysis and a longer-term model-based analysis. DISCUSSION The effective delivery of CRRT to critically ill patients ideally requires a standardised approach of best practice assessment and ongoing audit and feedback of standardised performance measures. QUALITY CRRT will test the application of this strategy stakeholder engagement and stepped-wedged implementation across an entire healthcare system. ETHICS AND DISSEMINATION This study has received ethics approval. We will plan to publish the results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04221932. PROTOCOL VERSION 1.0 (15 June 2020).
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Affiliation(s)
- Dawn Opgenorth
- Faculty of Medicine and Dentistry, Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen Reil
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Vincent Lau
- Faculty of Medicine and Dentistry, Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy Fraser
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Danny Zuege
- Department of Critical Care Medicine and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sean M Bagshaw
- Faculty of Medicine and Dentistry, Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Oleksa Rewa
- Faculty of Medicine and Dentistry, Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
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Vásquez Jiménez E, Anumudu SJ, Neyra JA. Dose of Continuous Renal Replacement Therapy in Critically Ill Patients: A Bona Fide Quality Indicator. Nephron Clin Pract 2021; 145:91-98. [PMID: 33540417 DOI: 10.1159/000512846] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/24/2020] [Indexed: 11/19/2022] Open
Abstract
Acute kidney injury (AKI) is common in critically ill patients, and renal replacement therapy (RRT) constitutes an important aspect of acute management during critical illness. Continuous RRT (CRRT) is frequently utilized in intensive care unit settings, particularly in patients with severe AKI, fluid overload, and hemodynamic instability. The main goal of CRRT is to timely optimize solute control, acid-base, and volume status. Total effluent dose of CRRT is a deliverable that depends on multiple factors and therefore should be systematically monitored (prescribed vs. delivered) and iteratively adjusted in a sustainable mode. In this manuscript, we review current evidence of CRRT dosing and provide recommendations for its implementation as a quality indicator of CRRT delivery.
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Affiliation(s)
- Enzo Vásquez Jiménez
- Department of Nephrology, National Institute of Cardiology Mexico, Mexico City, Mexico
| | - Samaya J Anumudu
- Division of Nephrology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA,
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Liu KD, Forni LG, Heung M, Wu VC, Kellum JA, Mehta RL, Ronco C, Kashani K, Rosner MH, Haase M, Koyner JL. Quality of Care for Acute Kidney Disease: Current Knowledge Gaps and Future Directions. Kidney Int Rep 2020; 5:1634-1642. [PMID: 33102955 PMCID: PMC7569680 DOI: 10.1016/j.ekir.2020.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
Acute kidney injury (AKI) and acute kidney disease (AKD) are common complications in hospitalized patients and are associated with adverse outcomes. Although consensus guidelines have improved the care of patients with AKI and AKD, guidance regarding quality metrics in the care of patients after an episode of AKI or AKD is limited. For example, few patients receive follow-up laboratory testing of kidney function or post-AKI or AKD care through nephrology or other providers. Recently, the Acute Disease Quality Initiative developed a consensus statement regarding quality improvement goals for patients with AKI or AKD specifically highlighting efforts regarding quality and safety of care after hospital discharge after an episode of AKI or AKD. The goal is to use these measures to identify opportunities for improvement that will positively affect outcomes. We recommend that health care systems quantitate the proportion of patients who need and actually receive follow-up care after the index AKI or AKD hospitalization. The intensity and appropriateness of follow-up care should depend on patient characteristics, severity, duration, and course of AKI of AKD, and should evolve as evidence-based guidelines emerge. Quality indicators for discharged patients with dialysis requiring AKI or AKD should be distinct from end-stage renal disease measures. Besides, there should be specific quality indicators for those still requiring dialysis in the outpatient setting after AKI or AKD. Given the limited preexisting data guiding the care of patients after an episode of AKI or AKD, there is ample opportunity to establish quality measures and potentially improve patient care and outcomes. This review will provide specific evidence-based and expert opinion–based guidance for the care of patients with AKI or AKD after hospital discharge.
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Affiliation(s)
- Kathleen D Liu
- Division of Nephrology, Departments of Medicine and Anesthesia, University of California, San Francisco, California, USA
- Division of Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, California, USA
| | - Lui G Forni
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ravindra L Mehta
- Division of Nephrology, Department of Medicine, University of California, San Diego Medical Center, San Diego, San Diego, California, USA
| | - Claudio Ronco
- Department of Medicine (DIMED), University of Padova, Padova, Italy
- Department of Nephrology, Dialysis and Transplantation, and International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Haase
- Medical Faculty, Otto-von-Guericke University Magdeburg and Diaverum MVZ, Potsdam, Germany
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Abarca Rozas B, Mestas Rodríguez M, Widerström Isea J, Lobos Pareja B, Vargas Urra J. A current view on the early diagnosis and treatment of acute kidney failure. Medwave 2020; 20:e7928. [DOI: 10.5867/medwave.2020.05.7928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/18/2020] [Indexed: 11/27/2022] Open
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Mottes TA. Does Your Program Know Its AKI and CRRT Epidemiology? The Case for a Dashboard. Front Pediatr 2020; 8:80. [PMID: 32211353 PMCID: PMC7068810 DOI: 10.3389/fped.2020.00080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Current acute kidney injury (AKI) literature focuses on diagnosis, treatment, and outcomes. While little literature exists studying the quality of care delivered to patients with AKI. However, improving outcomes for patients is dependent on the specifics of the delivered care (i.e., the who, what, when, and how). Therefore, it is necessary to direct attention to process measures to assess the relationship between care and outcomes. The application of quality improvement science to the care of AKI, uses a series of metrics encompassing both processes and outcomes to better understand, evaluate, and ensure the delivery high quality care.
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Affiliation(s)
- Theresa A Mottes
- Texas Children's Hospital, Renal Section, Houston, TX, United States
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Kashani K, Rosner MH, Haase M, Lewington AJ, O'Donoghue DJ, Wilson FP, Nadim MK, Silver SA, Zarbock A, Ostermann M, Mehta RL, Kane-Gill SL, Ding X, Pickkers P, Bihorac A, Siew ED, Barreto EF, Macedo E, Kellum JA, Palevsky PM, Tolwani AJ, Ronco C, Juncos LA, Rewa OG, Bagshaw SM, Mottes TA, Koyner JL, Liu KD, Forni LG, Heung M, Wu VC. Quality Improvement Goals for Acute Kidney Injury. Clin J Am Soc Nephrol 2019; 14:941-953. [PMID: 31101671 PMCID: PMC6556737 DOI: 10.2215/cjn.01250119] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022]
Abstract
AKI is a global concern with a high incidence among patients across acute care settings. AKI is associated with significant clinical consequences and increased health care costs. Preventive measures, as well as rapid identification of AKI, have been shown to improve outcomes in small studies. Providing high-quality care for patients with AKI or those at risk of AKI occurs across a continuum that starts at the community level and continues in the emergency department, hospital setting, and after discharge from inpatient care. Improving the quality of care provided to these patients, plausibly mitigating the cost of care and improving short- and long-term outcomes, are goals that have not been universally achieved. Therefore, understanding how the management of AKI may be amenable to quality improvement programs is needed. Recognizing this gap in knowledge, the 22nd Acute Disease Quality Initiative meeting was convened to discuss the evidence, provide recommendations, and highlight future directions for AKI-related quality measures and care processes. Using a modified Delphi process, an international group of experts including physicians, a nurse practitioner, and pharmacists provided a framework for current and future quality improvement projects in the area of AKI. Where possible, best practices in the prevention, identification, and care of the patient with AKI were identified and highlighted. This article provides a summary of the key messages and recommendations of the group, with an aim to equip and encourage health care providers to establish quality care delivery for patients with AKI and to measure key quality indicators.
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Affiliation(s)
- Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | | | - Michael Haase
- Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Medical Care Center Diaverum, Potsdam, Germany
| | - Andrew J.P. Lewington
- Renal Department, St. James’s University Hospital, Leeds, United Kingdom
- National Institute for Health Research (NIHR) In-Vitro Diagnostic Co-operative, Leeds, United Kingdom
| | - Donal J. O'Donoghue
- Department of Renal Medicine, Salford Royal National Health Services Foundation Trust, Stott Lane, Salford, United Kingdom
| | - F. Perry Wilson
- Yale University School of Medicine, Program of Applied Translational Research, New Haven, Connecticut
| | - Mitra K. Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Samuel A. Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen’s University, Kingston, Ontario, Canada
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Marlies Ostermann
- King’s College London, Guy’s and St. Thomas’ Hospital, London, United Kingdom
| | - Ravindra L. Mehta
- Division of Nephrology, Department of Medicine, University of California, San Diego Medical Center, San Diego, San Diego, California
| | | | - Xiaoqiang Ding
- Department of Nephrology, Shanghai Institute for Kidney Disease and Dialysis, Shanghai Medical Center for Kidney Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Azra Bihorac
- Precision and Intelligent Systems in Medicine, Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Kidney Disease and Integrated Program for AKI Research, Nashville, Tennessee
- Tennessee Valley Healthcare System, Veterans Administration Medical Center, Veteran’s Health Administration, Nashville, Tennessee
| | - Erin F. Barreto
- Department of Pharmacy, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California, San Diego Medical Center, San Diego, San Diego, California
| | - John A. Kellum
- Department of Critical Care Medicine, School of Medicine, and
| | - Paul M. Palevsky
- Department of Critical Care Medicine, School of Medicine, and
- Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Ashita Jiwat Tolwani
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Claudio Ronco
- Department of Nephrology, University of Padova, Padova, Italy
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Regione Veneto, Vicenza, Italy
- International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
| | - Luis A. Juncos
- Division of Nephrology, Central Arkansas Veterans’ Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Oleksa G. Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jay L. Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Kathleen D. Liu
- Divisions of Nephrology and Critical Care, Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, California
| | - Lui G. Forni
- Department of Clinical and Experimental Medicine, University of Surrey and Royal Surrey County Hospital National Health Services Foundation Trust, Guildford, United Kingdom
| | - Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Heung M, Bagshaw SM, House AA, Juncos LA, Piazza R, Goldstein SL. CRRTnet: a prospective, multi-national, observational study of continuous renal replacement therapy practices. BMC Nephrol 2017; 18:222. [PMID: 28683729 PMCID: PMC5501006 DOI: 10.1186/s12882-017-0650-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background Continuous renal replacement therapy (CRRT) is the recommended modality of dialysis for critically ill patients with hemodynamic instability. Yet there remains significant variability in how CRRT is prescribed and delivered, and limited evidence-basis to guide practice. Methods This is a prospective, multi-center observational study of patients undergoing CRRT. Initial enrollment phase will occur at 4 academic medical centers in North America over 5 years, with a target enrollment of 2000 patients. All adult patients (18–89 years of age) receiving CRRT will be eligible for inclusion; patients who undergo CRRT for less than 24 h will be excluded from analysis. Data collection will include patient characteristics at baseline and at time of CRRT initiation; details of CRRT prescription and delivery, including machine-generated treatment data; and patient outcomes. Discussion The goal of this study is to establish a large comprehensive registry of critically ill adults receiving CRRT. Specific aims include describing variations in CRRT prescription and delivery across quality domains; validating quality measures for CRRT care by correlating processes and outcomes; and establishing a large registry for use in quality improvement and benchmarking efforts. For initial analyses, some particular areas of interest are anticoagulation protocols; approach to fluid overload; CRRT-related workload; and patient safety. Trial registration Registered on ClinicalTrials.gov 1/10/2014: NCT02034448.
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Affiliation(s)
- Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA. .,, 1500 E. Medical Center Drive, SPC 5364, Ann Arbor, MI, 48109-5364, USA.
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, University Hospital London Health Sciences Centre, London, ONT, Canada
| | - Luis A Juncos
- Department of Medicine/Nephrology, and Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Robin Piazza
- Watermark Research Partners, Inc., Indianapolis, IN, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Askenazi DJ, Heung M, Connor MJ, Basu RK, Cerdá J, Doi K, Koyner JL, Bihorac A, Golestaneh L, Vijayan A, Okusa M, Faubel S. Optimal Role of the Nephrologist in the Intensive Care Unit. Blood Purif 2016; 43:68-77. [PMID: 27923227 PMCID: PMC5340591 DOI: 10.1159/000452317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.
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Affiliation(s)
- David J. Askenazi
- Department of Pediatrics—Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, USA
| | - Michael Heung
- Department of Medicine—Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J. Connor
- Department of Medicine—Division of Renal Medicine, Emory University, Atlanta, Georgia, USA
| | - Rajit K. Basu
- Center for Acute Care Nephrology, Cincinnati Children’s Hospital Center, Cincinnati, Ohio, USA
| | - Jorge Cerdá
- Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan
| | - Jay L. Koyner
- Department of Medicine—Section of Nephrology, University of Chicago, Chicago, Illinois, USA
| | - Azra Bihorac
- Department of Anesthesiology—University of Florida, Gainesville, Florida, USA
| | | | - Anitha Vijayan
- Division of Nephrology, Washington University, St Louis, Missouri, USA
| | - Mark Okusa
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sarah Faubel
- Department of Medicine—University of Colorado, and Denver VA Medical Center, Denver, Colorado, USA
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