PracticeUpdate Conference Series ISN WCN 2019

Undetected Community-Acquired Acute Kidney Injury Common in Low-Resource Settings Improved screening and point-of-care testing is needed to reduce disease progression andmortality.

C ommunity-acquired acute kidney injury is common yet frequently undetected in low- resource settings, but it can be uncovered with simple, low-cost point-of-care measures, according to research presented at WCN 2019. The risk factors for development of community- acquired acute kidney injury in low and lower-middle income countries have not been well-studied. In part, this reflects the heterogeneity of the condition as well as a lack of a standardized approach to evaluating renal dysfunction. As well, limited lab assessments and a dearth of information on the prior state of kidney health contribute to acute kidney injuries going undiagnosed, explain the study authors in their abstract. The current study, which was presented by Etienne Macedo, MD, of the University of California, San Diego, evaluated the risk factors associated with acute kidney disease and the efficacy of both point-of-care serum creatinine and urine dipstick tests to identify patients with kidney dysfunction at presentation. The study was part of the International Society of Nephrology 0by25 Pilot Feasibility Project, which aims to eliminate preventable deaths from acute kidney injury worldwide by 2025. For this international study, 3577 patients were screened at community health centers and emergency departments for signs or symptoms associated with a high or moderate risk of devel- oping an acute kidney injury. When the presence of a risk was indicated, patients underwent point- of-care serum creatinine and urine dipstick tests.

At enrollment, patients were classified into one of three categories: ƒ ƒ chronic kidney disease, defined as the presence of proteinuria (>1+), and/or baseline serum creati- nine within 12 months by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 ; ƒ ƒ normal renal function, defined as no proteinuria and an eGFR >75 mL/min/1.73 m 2 ; or ƒ ƒ acute kidney disease that met neither criteria for chronic kidney disease nor normal renal function. An acute kidney injury was confirmed within 7 days by an increase or decrease of 0.3 mg/dL or a 1.5-fold increase in serum creatinine from the enrollment value. Of the 3577 patients that were screened, 2101 were enrolled, comprising 91% adults and 9% children. At the time of enrollment, 9% of patients had chronic kidney disease and 66% had acute kidney disease. At the 7-day mark, 30% of the patients met the criteria for an acute kidney injury: 67 (13%) from the normal renal function group, 470 (33%) from the acute kidney disease group, and 91 (46%) from the chronic kidney disease group. In comparison to patients with normal renal function, those with acute kidney disease had a higher frequency of diabetes mellitus, hypertension and chronic liver disease. Use of ACE inhibitors, the antiviral drug tenofo- vir, and antibiotics (other than aminoglycosides) was more common in patients with acute kidney disease and injury. Dehydration associated with vomiting and low oral intake was the most common

PRACTICEUPDATE CONFERENCE SERIES • WCN 2019 18