Rates of Acute Kidney Injury among Irish patients have more than doubled in the past 10 years, according to a new study led by researchers at the Graduate Entry Medical School (GEMS), 51ÉçÇű. The research, part funded by the Health Research Board (HRB), is published today in the academic journal, Nephrology Dialysis Transplantation.
Acute Kidney Injury (AKI) describes the sudden and often temporary loss of kidney function that can occur when the kidney is damaged. There are many causes of AKI such as severe dehydration, acute illnesses like pneumonia, blood loss or even certain medications like anti-inflammatory drugs. In the long term, patients who suffer an AKI are more prone to kidney failure and early death.
Professor Austin Stack, lead author and Foundation Chair of Medicine at GEMS and Consultant Nephrologist at University Hospital Limerick said, âOur study has uncovered a huge surge in AKI rates over the past 10 years. We tracked over 450,000 patients in the Irish health system from 2005 to 2014 and identified more than 40,000 episodes of AKI. We found that the overall rate of AKI increased from 5.5% to 12.4% which was a growth of 126 %.â
In one of the largest studies of its kind ever conducted, researchers used data from the National Kidney Disease Surveillance System, based in ULâs Graduate Entry Medical School to track trends in the rates of AKI from 2005-2014. They found that the trend of rising rates of AKI was observed in both hospital and non-hospital clinical settings and among both men and women. The highest rates of AKI were detected among hospitalised patients where the rates increased from 28.8% in 2005 to 46.2% in 2014.
Dr Leonard Browne, senior author of the study and research fellow said, âThe increase in AKI could in part be explained by an increase in the number of elderly patients in the health system and a larger proportion of patients with poorer kidney function.â
AKI can range in severity from mild (Stage 1) to severe (Stage 3), where severe forms are more likely to cause kidney failure and require dialysis. According to the research findings, the most common form of AKI among Irish patients was Stage 1 which increased by 130%, (from 4.4% to 10.1%). The most severe form of AKI (Stage 3) increased by 76%, (from 0.46% to 0.81%).
According to Professor Stack, the findings show that action needs to be taken within the Irish healthcare system.
âThe Irish health system needs to respond with an appropriate multi-pronged cross-disciplinary approach. Acute Kidney Injury is a significant problem and puts patients at risk of kidney failure. The first step is to recognise that we have a problem across the health system. Key strategies to prevent AKI and its consequences include: greater public and physician awareness and education; early identification of high-risk individuals; early detection of AKI in all clinical settings using electronic alert systems; early use of treatment strategies including prevention of dehydration; avoidance of drugs that damage the kidneys; and, early referral to kidney specialists. We would advocate for the development and implementation of a national strategy designed to prevent the occurrence of AKI and its consequences in the health system.â
âOur study also has important international significance in that it for the first time sheds light on the differential growth of AKI by severity stage and across key clinical settings. Not only did we describe annual trends in the frequency of AKI by severity staging in the health system but we also highlighted major differences across key health care settings. We were intrigued by the fact that most of the increase in AKI incidence was accounted for by increases in AKI Stage 1 rather than stages 2 or 3. This would suggest that globally greater attention should be given to targeting these seemingly âminorâ AKI events and prevent the conversion of these events to more severe forms of AKI,â Professor Stack concluded.
The study Temporal Trends in Acute Kidney Injury across Healthcare Settings in the Irish Health System: A Cohort Study is published by Nephrology Dialysis Transplantation and authored by Austin G Stack, Xia Li, Mohamed Kaballo, Mohamed E Elsayed, Howard Johnson, Patrick Murray, Rajiv Saran, Leonard D Browne. It is available online here: .
This study was supported by the Health Research Board (HRA-2013-PHR-437 and HRA-2014-PHR-685), the Midwest Research and Education Foundation (MKid), and the Health Research Institute (HRI), 51ÉçÇű.
LĂ©irĂonn taighde nua go bhfuil ardĂș mĂłr tagtha ar rĂĄtaĂ GĂ©arghortuithe DuĂĄin i measc othair na hĂireann
TĂĄ na rĂĄtaĂ GĂ©arghortuithe DuĂĄin i measc othair na hĂireann mĂ©adaithe faoi dhĂł le 10 mbliana anuas. Is Ă© sin an toradh a bhĂ ar staidĂ©ar nua a rinne taighdeoirĂ sa Scoil Leighis IontrĂĄla IarchĂ©ime (GEMS), Ollscoil Luimnigh.
Is ionann GĂ©arghortĂș DuĂĄin (AKI) agus caillteanas tobann i bhfeidhm an duĂĄin, ar minic gur caillteanas sealadach Ă©. TĂĄ sĂ© seo in ann tarlĂș nuair atĂĄ damĂĄiste dĂ©anta don duĂĄn. Is iomaĂ cĂșis atĂĄ le AKI, mar atĂĄ drochdĂhiodrĂĄitiĂș, gĂ©arthinnis cosĂșil le niĂșmĂłine, caillteanas fola nĂł fiĂș cĂłgais ĂĄirithe cosĂșil le drugaĂ frith-athlastacha. Is mĂł seans i bhfad na haimsire go gclisfidh ar an duĂĄn agus go gcaillfear go luath na daoine sin a mbaineann AKI leo.
Labhair an tOllamh Austin Stack, prĂomhĂșdar an staidĂ©ir agus Ollamh FondĂșireachta Leighis in GEMS agus NeifreolaĂ Comhairleach in OspidĂ©al na hOllscoile, Luimneach mar seo a leanas, âThug ĂĄr staidĂ©ar chun solais go bhfuil ardĂș as cuimse tagtha ar rĂĄtaĂ AKI le 10 mbliana anuas. Rinneamar traiceĂĄil ar nĂos mĂł nĂĄ 450,000 othar i gcĂłras slĂĄinte na hĂireann sa trĂ©imhse 2005 go 2014 agus dâaithnĂomar os cionn 40,000 eipeasĂłid AKI. Fuaireamar amach gur ardaigh an rĂĄta AKI ar an iomlĂĄn Ăł 5.5% go 12.4%; is ionann Ă© sin agus ardĂș 126%.â
I gceann de na staidĂ©ir is mĂł dĂĄ leithĂ©id a rinneadh riamh, bhain taighdeoirĂ ĂșsĂĄid as sonraĂ Ăłn gCĂłras FaireachĂĄin NĂĄisiĂșnta ar Ghalar DuĂĄin, atĂĄ lonnaithe i Scoil Leighis IontrĂĄla IarchĂ©ime Ollscoil Luimnigh, chun na treochtaĂ i rĂĄtaĂ AKI Ăł 2005-2014 a rianĂș. Fuair siad amach go raibh an treocht seo, a lĂ©irigh go bhfuil rĂĄtaĂ AKI ag ardĂș, le tabhairt faoi deara i suĂomhanna cliniciĂșla sna hospidĂ©il fĂ©in agus lasmuigh de na hospidĂ©il, agus i measc na bhfear agus na mban araon. Braitheadh na rĂĄtaĂ is airde AKI i measc othair san ospidĂ©al, ĂĄit ar thĂĄinig ardĂș ar na rĂĄtaĂ Ăł 28.8% in 2005 go 46.2% in 2014.
Labhair an Dr Leonard Browne, Ășdar sinsearach an staidĂ©ir agus comhalta taighde, mar seo a leanas: âDâfhĂ©adfadh an mĂ©adĂș atĂĄ tagtha ar lĂon na ndaoine nĂos sine sa chĂłras slĂĄinte agus an cĂ©atadĂĄn nĂos mĂł othar a bhfuil feidhm duĂĄin nĂos laige acu cuid den ardĂș sa rĂĄta AKI a mhĂniĂș.â
TĂĄ raon dĂ©ine AKI idir Ă©adrom (CĂ©im 1) agus dian (CĂ©im 3), agus leis na cineĂĄlacha is dĂ©ine is mĂł seans go gclisfidh ar na duĂĄin agus go mbeidh scagdhealĂș de dhĂth. De rĂ©ir na dtorthaĂ seo, is Ă© CĂ©im 1 an cineĂĄl AKI is coitianta i measc othair na hĂireann; thĂĄinig ardĂș 130% air seo (Ăł 4.4% go 10.1%). ThĂĄinig ardĂș 76% ar an gcineĂĄl is dĂ©ine AKI (CĂ©im 3) (Ăł 0.46% go 0.81%).
NĂ mĂłr dul i mbun gnĂmh i gcĂłras slĂĄinte na hĂireann i bhfianaise na dtorthaĂ seo, a dĂșirt an tOllamh Stack.
âNĂ mĂłr do chĂłras slĂĄinte na hĂireann beart a dhĂ©anamh ina leith seo trĂ chur chuige cuĂ trasdisciplĂneach. Is fadhb shuntasach Ă© GĂ©arghortĂș DuĂĄin agus fĂĄgann sĂ© go mbĂonn othair i gcontĂșirt go gclisfidh ar na duĂĄin. Is Ă© an chĂ©ad chĂ©im a gcaithfear tabhairt faoi nĂĄ aithint go bhfuil fadhb againn sa chĂłras slĂĄinte trĂ chĂ©ile. I measc na bprĂomhstraitĂ©isĂ atĂĄ ann chun AKI agus a iarmhairtĂ a chosc, ĂĄirĂtear na cinn seo a leanas: feasacht a mhĂșscailt i measc an phobail agus dochtĂșirĂ, agus oideachas a chur orthu; na daoine sin a mbaineann ardriosca leo a aithint go luath, AKI a aimsiĂș go luath i ngach suĂomh cliniciĂșil trĂ ĂșsĂĄid a bhaint as cĂłrais folĂĄirimh leictreonaigh, straitĂ©isĂ cĂłireĂĄla a ĂșsĂĄid go luath a n-ĂĄirĂtear leo siĂșd dĂhiodrĂĄitiĂș a chosc, drugaĂ atĂĄ in ann damĂĄiste a dhĂ©anamh do na duĂĄin a sheachaint, agus othair a chur ar atreo luath go dtĂ speisialtĂłirĂ duĂĄin. TĂĄimid i bhfĂĄbhar straitĂ©is nĂĄisiĂșnta a fhorbairt agus a chur chun feidhme a mbeadh sĂ© de chuspĂłir aici minicĂocht AKI agus a iarmhairtĂ sa chĂłras slĂĄinte a chosc.
TĂĄ an staidĂ©ar Temporal Trends in Acute Kidney Injury across Healthcare Settings in the Irish Health System: A Cohort Study ĂĄ fhoilsiĂș ag Nephrology Dialysis Transplantation agus is iad Austin G Stack, Xia Li, Mohamed Kaballo, Mohamed E Elsayed, Howard Johnson, Patrick Murray, Rajiv Saran, Leonard D Browne na hĂșdair. TĂĄ sĂ© ar fĂĄil ar lĂne anseo:
Fuair an staidĂ©ar seo tacaĂocht Ăłn mBord Taighde SlĂĄinte (HRA-2013-PHR-437 agus HRA-2014-PHR-685), Ăł FhondĂșireacht Taighde agus Oideachais an MheĂĄn-Iarthair (Mkid), agus Ăłn InstitiĂșid Taighde SlĂĄinte (HRI), Ollscoil Luimnigh.