Taking action against acute kidney injury in primary care
With acute kidney injury often encountered in the outpatient setting, primary-care providers should know the basics of diagnosis and treatment.
Glomerulonephritis (shown), a cause of AKI, may occur after a bacterial infection.
This activity is provided by Haymarket Medical Education (HME) for physician credit.
This activity is co-provided by Medical Education Resources (MER) for nursing contact hours.
Joanna Lang, PA-C, MPAS
Midwest Nephrology Associates
Release Date: November 12, 2014
Expiration Date: November 11, 2015
Estimated time to complete the educational activity: 30 minutes
Statement of Need: Acute kidney injury (AKI) is increasing among hospitalized persons, and primary-care providers are often the clinicians to care for these patients after discharge. These practitioners also are positioned to identify patients at risk for acute kidney injury. Knowing the risk factors for and causes of this condition will enable primary-care clinicians to reduce morbidity and mortality among patients.
Target Audience: This activity has been designed to meet the educational needs of primary-care health-care professionals who will treat persons who have acute kidney injury or are at risk for the condition.
Learning Objectives: After completing the activity, the participant should be better able to:
- Define acute kidney injury based on RIFLE and AKIN criteria
- Describe risk factors associated with acute kidney injury
- Differentiate among the prerenal, intrinsic/renal, and postrenal causes of acute kidney injury
- Apply knowledge of the specific causes of acute kidney injury to treatment of the patient.
Physician Credit: HME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation: HME designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing Credit: MER is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Credit Designation: This CE activity provides 0.5 contact hour of continuing nursing education. MER is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299, for 0.5 contact hour.
This activity qualifies for 0.13 pharmacotherapy credit.
American Academy of Physician Assistants (AAPA)
The AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 0.5 hour of Category I credit for completing this program.
In accordance with the ACCME Standards for Commercial Support, HME requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. HME resolves all conflicts of interest in an effort to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Furthermore, HME seeks to verify that all scientific research referred to, reported, or used in a CME/CE activity conforms to the generally accepted standards of experimental design, data collection, and analysis. HME is committed to providing its learners with high-quality CME/CE activities that promote improvements in health care and not those of a commercial interest.
The faculty reported the following financial relationships with commercial interests whose products or services may be mentioned in this CME/CE activity:
|Name of Faculty||Financial Relationship|
|Joanna Lang, PA-C, MPAS
||No relevant financial relationships|
The planners and managers for this program reported the following financial relationships with commercial interests whose products or services may be related to the content of this CME activity:
HME planners and managers have no relevant financial relationships to disclose.
MER planners and managers have no relevant financial relationships to disclose.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. HME and MER do not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Method of Participation: There are no fees for participating in and receiving CME/CE credit for this activity. During the period of November 12, 2014 to November 11, 2015 participants must:
- Read the learning objectives and faculty disclosures;
- Study the educational activity;
- Submit the post-test online (clinicians may register at www.mycme.com);
- Complete the evaluation form online
A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.
Disclaimer: The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of HME or MER. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.
HOW TO TAKE THE POST-TEST: Click here after reading the article to take the post-test on myCME.com.
Acute kidney injury (AKI) is a common occurrence, especially among hospitalized patients. It is estimated that 15% of persons admitted to the hospital will develop AKI and that even mild AKI is associated with an increase in morbidity, mortality, and hospital costs. 1,2
Additionally, AKI places a patient at increased risk of developing chronic kidney disease (CKD) in the future. 3-5 This is independent of the cause of AKI; however, the more severe the AKI, the higher the risk of progression to CKD. For example, progression to stage 4 CKD is found to be more rapid in cases of acute tubular necrosis. 4
According to a study published in 2007, the prevalence of AKI upon admission to the intensive-care unit (ICU) was found to be 36.1%. 6 Patients undergoing cardiac surgery have up to a 30% chance of developing AKI; 3% of these individuals will require dialysis. 1
However, AKI is not just a hospital problem. Primary-care providers also must have an understanding of the common causes and treatments. These clinicians often will be the practitioners to administer follow-up care once a hospitalized patient is discharged, and they also may identify those patients at risk ( Figure 1 ).
Table 1: Definitions of acute kidney injury7
|System||Serum creatinine criteria||Urine output criteria|
|Risk||Serum creatinine increases 1.5-fold or GFR decreases >25% from baseline.||<0.5 mL/kg/h for >6 h|
|Injury||Serum creatinine increases 2.0-fold or GFR decreases >50% from baseline.||<0.5 mL/kg/h for >12 h|
|Failure||Serum creatinine increases >3.0-fold or serum creatinine is >4 mg/dL with an acute increase >0.5 mg/dL or GFR decreases >75% from baseline||anuria for 12 h|
|1||Serum creatinine increases ≥0.3 mg/dL or increases 1.5–2.0-fold from baseline.||<0.5 mL/kg/h for >6 h|
|2||Serum creatinine increases >2.0–3.0-fold from baseline.||<0.5 mL/kg/h for >12 h|
|3||Serum creatinine increases >3.0-fold from baseline or serum creatinine is >4.0 mg/dL with an acute increase of ≥0.5 mg/dL or RRT is needed.||<0.3 mL/kg/h for 24 h or anuria for 12 h|
|AKIN = Acute Kidney Injury Network (akinet.org); GFR = glomerular filtration rate; RIFLE = Risk, Injury, Failure; Loss, End-Stage Renal Disease (of the Acute Dialysis Quality Initiative; adqi.org); RRT = renal replacement therapy
Adapted from Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012;2:1-138 (Table 3).7