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S 25 Parallel Session
Programme of the Session
Title: Acute Kidney Injury
GS: Fiona Loud (UK)
Thinking kidneys: the British Kidney Patient Association working collaboratively to reduce acute kidney injury
O 55
CRRT in patients with AKI. Experience from tertiary care center in Croatia
Bosiljka Devci (Croatia)
O 56
Urinary tract infections in kidney transplanted patients
Jeanette Finderup (Denmark)
O 57
Factors affecting the post-dialysis levels of vancomycin and gentamicin in haemodialysis patients
Albert Acheamfour (UK)
O 58
The Undocumented Immigrants – a challenge of treatment
Iris Romach (Israel)
Abstracts
GUEST SPEAKER
Thinking kidneys: the British Kidney Patient Association working collaboratively to reduce acute kidney injury
F. Loud1
1Policy, British Kidney Patient Association, Alton, United Kingdom
Background
In the UK up to 100,000 deaths in hospitals each year are associated with Acute KIdney Injury (AKI), it is estimated that 30% of them could be prevented with the right care and treatment.
Objectives
The National Health Service in England has for the past 3 years developed a ‘Think Kidneys’ campaign to tackle avoidable harm, in which the BKPA was a founder member. The talk will illustrate the innovative work of the programme and how a patient charity supported and enhanced its work.
Methods
A multi-disciplinary team was established with workstreams for risk, education, intervention, hydration, measurement, detection and implementation.
It developed education, interventions, guidance and introduced a warning algorithm to detect AKI in hospitals and subsequently in general practice. As a patient charity the BKPA was very aware of the lack of information for patients at risk of or recovering from AKI and collaborated to produce supportive patient-facing information, and to make sure the patient voice was heard in the work of the programme.
Results
The wide ranges of resources and the 300+ people who worked on this programme have created excellent resources which are now being used in the NHS to reduce the avoidable harm of AKI.
Conclusion/Application to practice
The full impact of the programme is under evaluation but the extensive work of this programme demonstrates clearly what can be achieved through collaboration, determination and appropriate funding.
BIOGRAPHY OF THE GUEST SPEAKER
O 55
CRRT in patients with AKI - experience from a tertiary care center in Croatia
B. Devci1, V. Racki2, M. Praskalo2, B. Madzar1, I. Mikolasevic1, L. Orlic1, S. Racki1
1Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Centre Rijeka, Rijeka, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia
Background
Continuous renal replacement therapy (CRRT) is one of the methods for the treatment of acute kidney injury (AKI). We analyzed the patients and treatment characteristics as well as effect of CRRT on the outcome of our patients with AKI. receiving CRRT
Objectives
In this retrospective study, we have analyzed a total of 299 patients treated with CRRT in the intensive care unit (ICU) during the period 1st of January 2010 to the 30th of June 2015.
Methods
Patients’ demographic characteristics, as well as prescribed CRRT therapy and patients’ outcome were analyzed.
Results
Out of 299 analyzed patients, there were 201 (67%) men and 98 (33%) women with an average age over 65 years of age (ranging from 1-89 years). The most common prescribed treatment was a continuous veno-venous haemodialysis (CVVHD) (85% of our patients CVVHDF using AN69 membrane applied in 11 (29%) patients. Of 299 analyzed patients, 107 (35.8%) of them died, while, 23 (7.7%) of patients did not recover their renal function and continued further renal replacement therapy. One hundred and thirty (56.5%) patients had recovered their renal function in the end of the CRRT treatment.
Conclusion/Application to practice
The mortality rate of our AKI patients treated with CRRT was around 50%. Although, the mortality rate in patients with AKI treated with CRRT is still high, the percentage of patients with preserved renal function is increasing.
O 56
Urinary tract infections in kidney transplanted patients
J. Finderup1, J.P. Hoffmann2, T. Hoeher-Thomsen2
1The Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark; 2Via University College, Aarhus N, Denmark
Background
Urinary tract infections (UTI) in kidney transplanted (TX) patients increase the risk for rejection and loss of the graft. It is thus important that TX patient with a UTI receive appropriate care and treatment. Two years ago a clinical guideline on care and treatment in relation to UTI was implemented.
Objectives
To estimate the quality and identify quality flaws in the diagnosis of TX with a UTI before and after the introduction of a guideline on UTI care.
Methods
A clinical qualitative audit of the medical record for 135 patients covering a period of 3.5 years. The period was separated by the time for the introduction of the guideline. Relevant data was quantified and analysed by simple statistics.
Results
Quality flaws were identified but also improvements in the diagnosis of cystitis, pyelonephritis and urosepsis after implementation of the guideline. The number of patients with a UTI has decreased. An increasing number of patients go through the right diagnostic procedures and receive treatment, but still there is a need for improvement. A few patients had a UTI less than 50 days after TX. Most of the patients had a UTI more than 120 day after TX and had several UTIs.
Conclusion/Application to practice
The quality has increased after the introduction of the guideline but there is still a need for improvement. The results indicate that earlier removal of the JJ-catheter maybe improve quality. Prevention and early detection of UTI may be the best way to improve quality in TX patients contracting a UTI.
O 57
Factors affecting the post-dialysis levels of vancomycin and gentamicin in haemodialysis patients
A. Acheamfour1, E.Tungu-Dabu1, M. Giannopoulous1, B. Sood1, D. Makanjuola1
1Renal Unit, St. Helier Hospital, Surrey, United Kingdom
Background
Patients undergoing dialysis are prone to dialysis access related infections. Empirical antibiotic therapy in our unit is Vancomycin and Gentamicin. Delays in obtaining drug levels can lead to missed doses, or inappropriately administered doses, which could adversely affect the patient.
Objectives
We investigated whether there were any parameters which could help predict what the percentage reduction of the pre-dialysis drug levels would be following a dialysis session.
Methods
Inpatients on antibiotic therapy for various indications were included. All patients were on haemodiafiltration using FX60 high-flux dialysers. Data on weight, dialysis access type, blood pump speed, duration of dialysis, litres processed per session, ultrafiltration volume, time on dialysis and Vancomycin and Gentamicin levels were collected and analysed.
Results
88 samples were collected from 21 patients, 62% were male, mean age 70.2 years. The only positive correlation was between the litres processed per session adjusted for body weight pre-dialysis (R2 = 0.23). This was not the case with ultrafiltration volume/kg body weight (R2 = 0.003).
Conclusion/Application to practice
The best correlation with the percentage reduction in drug level following dialysis was the litres processed adjusted for pre-dialysis body weight. All our patients were using high-flux dialysers and were on HDF, so it is not clear whether this would apply to patients using either low-flux dialysers, or patients on haemodialysis rather than HDF. If it is possible to come up with a ‘nomogram’, based on a few of these parameters to guide antibiotic dosing, it would be of great benefit, especially in the outpatient setting.
O 58
The Undocumented Immigrants – a treatment challenge
I. Romach1, J. Jenin1, A. Gal-oz1, I. Gutman1, A. Veretnik1
1Dialysis, Tel Aviv souraski Medical Center, Tel Aviv, Israel
Background
Immigrants and refugees are a vulnerable population. They have no medical insurance, and their compliance is low. Though there is a free clinic serving the undocumented immigrants, they do not use it, thus arriving at the hospital in critical conditions including Chronic Kidney Disease (CKD) stage 5, necessitating urgent Haemodialysis Treatment (HD) via temporary catheter. Morbidity and mortality rates among them are very high.
Objectives
Two undocumented immigrants were hospitalized with CKD stage 5. They started their dialysis treatment via temporary and later permanent tunneled cuffed catheters - both compassionate. Definite peripheral vascular access or Kidney Transplantation were not an option.
Results
: 3-4 years after initiating HD both patients developed access failure. They started Peritoneal Dialysis (PD). It took several episodes of Peritonitis and Peritoneal Catheter changes, prolonged hospitalizations and massive broad spectrum, expensive antibiotic treatment, until finally the PD Treatment was exhausted. The last access possible was a Trans lumbar HD Permacath.
Both were noncompliant due to financial limitations. We partly supplied their medications by including them in several research projects (Anemia, Bone Dis.), other patients who donated some medications, samples donated by pharmaceutical companies, and leftovers. This was suboptimal treatment, but it was enough to keep them alive.
Their debt is 1,053,323 Euro for 10 years and 593,434 Euro for 6 years, respectively.
Conclusion/Application to practice
Preventing morbidity and mortality among Undocumented Immigrants is challenging and requires creativity. Local health suppliers and Nephrologists should find solutions and financial resources to treat those patients according to the international guidelines.