Abstract
The purposeof the research: to analyze the quality of medical care of patients who are at risk of developing acute kidney injury.Materials and methods. The work is based on a retrospective analysis of medical records of 140 patients with an acute kidney injury developed during their stay the intensive care units, surgical and medical units of district hospitals the Irkutsk Oblast over the period from 2012 to 2017.Results. Inadequate assessment of the risk of an acute kidney injury was identified in 61% of patients. The most common inadequately assessed damaging factors were critical conditions (in 36% (50/140), sepsis (27% (38/140), and nephrotoxic drugs (19% (26/140). Among inadequately evaluated predisposing factors that could be managed, the following ones were most common: chronic heart disease (in 42% (59/140), dehydration/hypovolaemia (34% (47/140), chronic kidney disease (29% (41/140), and anemia (25% (35/140). In patients at risk of an acute kidney injury, an inadequate examination and inadequate maintenance therapy were found in 66% and 56% cases, respectively. Analysis of implementation of supporting therapy in patients at risk of an acute kidney injury the following misconducting events were revealed: (i) no optimal volumic and perfusion support (59% (82/140) and (ii) no cancellation of nephrotoxic and improperly prescribed drugs (31% (44/140).Conclusions. A good quality medical care restricted only by 24% of patients at risk of an acute kidney injury developed in the ICU, surgical and medical departments of district hospitals of the Irkutsk Oblast. The development of an acute kidney injury when exposed to nephrotoxic drugs and dehydration/ hypovolemia in 14% of cases was predictable and preventable.
Highlights
An acute kidney injury (AKI) is a condition that occurs due to well-known factors damaging the kidneys in patients with predisposing factors (dehydration/hypovolemia, advanced age, female gender, chronic kidney disease, сhronic diseases, diabetes mellitus, malignant neoplasms, anemia) or without them
The probability of AKI, its severity and prognosis are determined by the number, type, and duration of exposure to damaging and predisposing factors, as well as the quality of the medical care [1, 2]
The quality of medical care was assessed according to Order No 17n of the Ministry of Health of Russia as of 18.01.2012 «On Approval of the Procedure for Rendering Medical Care to the Adult Population in the Field of Nephrology» [12], clinical guidelines of the Scientific Society of Nephrologists of Russia on the diagnosis and treatment of the AKI 2014 [2] and 2012 Kidney Disease: Improving Global Outcomes (KDIGO) [1]
Summary
An acute kidney injury (AKI) is a condition that occurs due to well-known factors damaging the kidneys (nephrotoxic drugs, radiocontrast agents, sepsis, critical conditions, shock, trauma, cardiac surgery, major noncardiac surgery, poisonous plants and animals) in patients with predisposing factors (dehydration/hypovolemia, advanced age, female gender, chronic kidney disease, сhronic diseases (heart, lung, liver), diabetes mellitus, malignant neoplasms, anemia) or without them. The probability of AKI, its severity and prognosis are determined by the number, type, and duration of exposure to damaging and predisposing factors, as well as the quality of the medical care [1, 2]. The need for the renal replacement therapy and the risk of death increases with increasing severity of the AKI [3,4,5,6]. Even reversible AKI and/or mild acute kidney impairment lead to a high probability of a cardiovascular disease and a chronic kidney disease, as well as to an increased risk of death [3, 5, 7, 8]
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