Acute Kidney Injury rose by 126% in Ireland between 2005 and 2014

Monday, 6th August 2018 Tags: University of Limerick, UL, Acute Kidney Injury, Austin Stack,

Rates of Acute Kidney Injury among Irish patients have more than doubled in the past 10 years, according to a new study led by researchers at the Graduate Entry Medical School (GEMS), University of Limerick. The research, part funded by the Health Research Board (HRB), is published today in the academic journal, Nephrology Dialysis Transplantation.

Acute Kidney Injury (AKI) describes the sudden and often temporary loss of kidney function that can occur when the kidney is damaged. There are many causes of AKI such as 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.

Professor Austin Stack, lead author and Foundation Chair of Medicine at GEMS and Consultant Nephrologist at University Hospital Limerick said, “Our study has uncovered a huge surge in AKI rates over the past 10 years. 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 %.”

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.

Dr 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 can range in severity from mild (Stage 1) to severe (Stage 3), where severe forms are more likely to cause kidney failure and require dialysis. According to the research findings, the most common form of AKI among Irish patients was Stage 1 which increased by 130%, (from 4.4% to 10.1%). The most severe form of AKI (Stage 3) increased by 76%, (from 0.46% to 0.81%).

According to Professor Stack, the findings show that action needs to be taken within the Irish healthcare system.
“The Irish health system needs to respond with an appropriate multi-pronged cross-disciplinary approach. 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.”


“Our study also has important international significance in that it for the first time sheds light on the differential growth of AKI by severity stage and across key clinical settings. Not only did we describe annual trends in the frequency of AKI by severity staging in the health system but we also highlighted major differences across key health care settings. We were intrigued by the fact that most of the increase in AKI incidence was accounted for by increases in AKI Stage 1 rather than stages 2 or 3. This would suggest that globally greater attention should be given to targeting these seemingly ‘minor’ AKI events and prevent the conversion of these events to more severe forms of AKI,” Professor Stack concluded.

The study Temporal Trends in Acute Kidney Injury across Healthcare Settings in the Irish Health System: A Cohort Study is published by Nephrology Dialysis Transplantation and authored by Austin G Stack, Xia Li, Mohamed Kaballo, Mohamed E Elsayed, Howard Johnson, Patrick Murray, Rajiv Saran, Leonard D Browne. It is available online here: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfy226/5066152.

This study was supported by the Health Research Board (HRA-2013-PHR-437 and HRA-2014-PHR-685), the Midwest Research and Education Foundation (MKid), and the Health Research Institute (HRI), University of Limerick.

 

 

 

Léiríonn taighde nua go bhfuil ardú mór tagtha ar rátaí Géarghortuithe Duáin i measc othair na hÉireann


Tá na rátaí Géarghortuithe Duáin i measc othair na hÉireann méadaithe faoi dhó le 10 mbliana anuas. Is é sin an toradh a bhí ar staidéar nua a rinne taighdeoirí sa Scoil Leighis Iontrála Iarchéime (GEMS), Ollscoil Luimnigh.

Is ionann Géarghortú Duáin (AKI) agus caillteanas tobann i bhfeidhm an duáin, ar minic gur caillteanas sealadach é. Tá sé seo in ann tarlú nuair atá damáiste déanta don duán. Is iomaí cúis atá le AKI, mar atá drochdíhiodráitiú, géarthinnis cosúil le niúmóine, caillteanas fola nó fiú cógais áirithe cosúil le drugaí frith-athlastacha. Is mó seans i bhfad na haimsire go gclisfidh ar an duán agus go gcaillfear go luath na daoine sin a mbaineann AKI leo.

Labhair an tOllamh Austin Stack, príomhúdar an staidéir agus Ollamh Fondúireachta Leighis in GEMS agus Neifreolaí Comhairleach in Ospidéal na hOllscoile, Luimneach mar seo a leanas, “Thug ár staidéar chun solais go bhfuil ardú as cuimse tagtha ar rátaí AKI le 10 mbliana anuas. Rinneamar traiceáil ar níos mó ná 450,000 othar i gcóras sláinte na hÉireann sa tréimhse 2005 go 2014 agus d’aithníomar os cionn 40,000 eipeasóid AKI. Fuaireamar amach gur ardaigh an ráta AKI ar an iomlán ó 5.5% go 12.4%; is ionann é sin agus ardú 126%.”

I gceann de na staidéir is mó dá leithéid a rinneadh riamh, bhain taighdeoirí úsáid as sonraí ón gCóras Faireacháin Náisiúnta ar Ghalar Duáin, atá lonnaithe i Scoil Leighis Iontrála Iarchéime Ollscoil Luimnigh, chun na treochtaí i rátaí AKI ó 2005-2014 a rianú. Fuair siad amach go raibh an treocht seo, a léirigh go bhfuil rátaí AKI ag ardú, le tabhairt faoi deara i suíomhanna cliniciúla sna hospidéil féin agus lasmuigh de na hospidéil, agus i measc na bhfear agus na mban araon. Braitheadh na rátaí is airde AKI i measc othair san ospidéal, áit ar tháinig ardú ar na rátaí ó 28.8% in 2005 go 46.2% in 2014.

Labhair an Dr Leonard Browne, údar sinsearach an staidéir agus comhalta taighde, mar seo a leanas: “D’fhéadfadh an méadú atá tagtha ar líon na ndaoine níos sine sa chóras sláinte agus an céatadán níos mó othar a bhfuil feidhm duáin níos laige acu cuid den ardú sa ráta AKI a mhíniú.”

Tá raon déine AKI idir éadrom (Céim 1) agus dian (Céim 3), agus leis na cineálacha is déine is mó seans go gclisfidh ar na duáin agus go mbeidh scagdhealú de dhíth. De réir na dtorthaí seo, is é Céim 1 an cineál AKI is coitianta i measc othair na hÉireann; tháinig ardú 130% air seo (ó 4.4% go 10.1%). Tháinig ardú 76% ar an gcineál is déine AKI (Céim 3) (ó 0.46% go 0.81%).

Ní mór dul i mbun gnímh i gcóras sláinte na hÉireann i bhfianaise na dtorthaí seo, a dúirt an tOllamh Stack.
“Ní mór do chóras sláinte na hÉireann beart a dhéanamh ina leith seo trí chur chuige cuí trasdisciplíneach. Is fadhb shuntasach é Géarghortú Duáin agus fágann sé go mbíonn othair i gcontúirt go gclisfidh ar na duáin. Is é an chéad chéim a gcaithfear tabhairt faoi ná aithint go bhfuil fadhb againn sa chóras sláinte trí chéile. I measc na bpríomhstraitéisí atá ann chun AKI agus a iarmhairtí a chosc, áirítear na cinn seo a leanas: feasacht a mhúscailt i measc an phobail agus dochtúirí, agus oideachas a chur orthu; na daoine sin a mbaineann ardriosca leo a aithint go luath, AKI a aimsiú go luath i ngach suíomh cliniciúil trí úsáid a bhaint as córais foláirimh leictreonaigh, straitéisí cóireála a úsáid go luath a n-áirítear leo siúd díhiodráitiú a chosc, drugaí atá in ann damáiste a dhéanamh do na duáin a sheachaint, agus othair a chur ar atreo luath go dtí speisialtóirí duáin. Táimid i bhfábhar straitéis náisiúnta a fhorbairt agus a chur chun feidhme a mbeadh sé de chuspóir aici minicíocht AKI agus a iarmhairtí sa chóras sláinte a chosc.
 
Tá an staidéar Temporal Trends in Acute Kidney Injury across Healthcare Settings in the Irish Health System: A Cohort Study á fhoilsiú ag Nephrology Dialysis Transplantation agus is iad Austin G Stack, Xia Li, Mohamed Kaballo, Mohamed E Elsayed, Howard Johnson, Patrick Murray, Rajiv Saran, Leonard D Browne na húdair. Tá sé ar fáil ar líne anseo: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfy226

Fuair an staidéar seo tacaíocht ón mBord Taighde Sláinte (HRA-2013-PHR-437 agus HRA-2014-PHR-685), ó Fhondúireacht Taighde agus Oideachais an Mheán-Iarthair (Mkid), agus ón Institiúid Taighde Sláinte (HRI), Ollscoil Luimnigh.