Study: Acute kidney injuries double in 10 years

By Dan Buckley

Rates of acute kidney injury (AKI) among Irish patients have more than doubled in 10 years, a new study shows.

Research conducted at the University of Limerick shows a huge increase in AKI rates that can only be partly explained by a rise in the number of elderly patients in the health system.

Austin Stack, lead author of the study, said a national strategy to prevent the occurrence of AKI needs to be developed and implemented.

In one of the largest studies of its kind ever conducted, researchers used data from the National Kidney Disease Surveillance System, based in UL’s 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.

The study, led by researchers at UL’s Graduate Entry Medical School and part funded by the Health Research Board, is published today in the academic journal, Nephrology Dialysis Transplantation.

“Our study has uncovered a huge surge in AKI rates over the past 10 years,” said Prof Stack, foundation chair of Medicine at GEMS and Consultant Nephrologist at University Hospital Limerick.

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%.

Leonard Browne, senior author of the study and research fellow, said: “The 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.”

AKI involves the sudden loss of kidney function that can occur when the kidney is damaged by 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.

It can range from mild (stage 1) to severe (stage 3), where severe forms are more likely to cause kidney failure and require dialysis.

According to the findings, the most common form of AKI among Irish patients was stage 1 which increased by 130% while stage 3 increased by 76%.

According to Prof Stack, action needs to be taken.

“The Irish health system needs to respond with an appropriate multi-pronged cross-disciplinary approach,” he said.

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.”