Ak Prevention
How can AKI be prevented?
According to the National Confidential Enquiry into Patient Outcome and Death 2009, up to 30% of cases of acute kidney injury may be preventable and the best 'treatment of AKI is prevention.' [3]This can mainly be done by identifying patients most at risk as early as possible. This would involve constant monitoring of urinary output and serum creatinine levels for the high risk patients. However in general, all hospitalized patients with acute illness should be monitored for any symptoms of AKI. In addition minimising the patient’s exposure to nephrotoxic drugs and iodinated contrast agents reduces risk of diagnosis drastically. [3]
However, as mentioned before, AKI is not just a secondary care problem – primary care …show more content…
[13] This small card has detailed instructions for temporary cessation of these particular medications, which could be exacerbating and worsening the AKI symptoms. The mnemonic DAMN can be used to remember these drugs.(diuretics, ACEi/ ARBs, metformin, NSAIDs).[8]
Prevention of AKI should follow the following principles;
Risk Assessment
In terms of simply identifying hospitalized patients who would be most at risk, all patients on admission and during their hospital stay should be assessed regularly. The figure to the left gives an example of a risk assessment tool used in the Southern Health and Social Care Trust. [5] AKI in surgical patients is common. Recognising patients at high risk will allow actions to be taken to reduce incidence of renal injury and promote renal recovery as soon as possible. [5]
Optimisation of fluid balance
Patients at risk should have their fluid volume status carefully monitored including fluid depletion and fluid overload. If fluid depletion is high, and oral intake is low, and the patients is at risk of dehydration, according to NICE guidelines the patient should be prescribed maintenance IV …show more content…
[31] The table below is a review of five studies and their findings on the clinical uses of loop diuretics and their effects on mortality rates in AKI. All five studies used furosemide, but a variety of doses were used, with maximal daily doses ranging from under 1g to 3.2g.[31] It shows inappropriate use of loop diuretics may exacerbate renal hypoperfusion through vasodilatation and excessive diuresis resulting in worse outcomes. It is therefore essential to assess the role of loop diuretics in treating established
According to the National Confidential Enquiry into Patient Outcome and Death 2009, up to 30% of cases of acute kidney injury may be preventable and the best 'treatment of AKI is prevention.' [3]This can mainly be done by identifying patients most at risk as early as possible. This would involve constant monitoring of urinary output and serum creatinine levels for the high risk patients. However in general, all hospitalized patients with acute illness should be monitored for any symptoms of AKI. In addition minimising the patient’s exposure to nephrotoxic drugs and iodinated contrast agents reduces risk of diagnosis drastically. [3]
However, as mentioned before, AKI is not just a secondary care problem – primary care …show more content…
[13] This small card has detailed instructions for temporary cessation of these particular medications, which could be exacerbating and worsening the AKI symptoms. The mnemonic DAMN can be used to remember these drugs.(diuretics, ACEi/ ARBs, metformin, NSAIDs).[8]
Prevention of AKI should follow the following principles;
Risk Assessment
In terms of simply identifying hospitalized patients who would be most at risk, all patients on admission and during their hospital stay should be assessed regularly. The figure to the left gives an example of a risk assessment tool used in the Southern Health and Social Care Trust. [5] AKI in surgical patients is common. Recognising patients at high risk will allow actions to be taken to reduce incidence of renal injury and promote renal recovery as soon as possible. [5]
Optimisation of fluid balance
Patients at risk should have their fluid volume status carefully monitored including fluid depletion and fluid overload. If fluid depletion is high, and oral intake is low, and the patients is at risk of dehydration, according to NICE guidelines the patient should be prescribed maintenance IV …show more content…
[31] The table below is a review of five studies and their findings on the clinical uses of loop diuretics and their effects on mortality rates in AKI. All five studies used furosemide, but a variety of doses were used, with maximal daily doses ranging from under 1g to 3.2g.[31] It shows inappropriate use of loop diuretics may exacerbate renal hypoperfusion through vasodilatation and excessive diuresis resulting in worse outcomes. It is therefore essential to assess the role of loop diuretics in treating established