Overview of Acute Kidney Injury and Chronic Kidney Disease Ali K. Abu-Alfa, MD, FASN Professor of Medicine Head, Division of Nephrology & Hypertension Director, Human Research Protection Program and the Clinical Research Institute American University of Beirut

WORLD KIDNEY DAY 2015 at AUBMC MARCH 7, 2015

Disclosure No Financial or Intellectual Conflicts of Interest.

Objectives  



 

Overview of the World Kidney Day Initiative Review the definition of Acute Kidney Injury (AKI) Present the latest KDIGO (December 2012) CKD definition and staging system Discuss common causes of AKI and CKD Review impact of CKD on outcomes

Acute Kidney Injury 







AKI refers to acute decline in renal function, from normal or abnormal levels. It is a common occurrence among hospitalized patients. AKI is heterogeneous in presentation, causes and course. AKI can necessitate the need for dialysis.

Acute Kidney Injury: Evolution

Lewington AJ et al. Kidney Int. 2013; 84: 457–467

Acute Kidney Injury: Causes

● Acute Tubular Necrosis ● Pre-renal disease ● Acute superimposed on CKD ● Urinary tract obstruction ● Glomerulonephritis or vasculitis ● Acute interstitial nephritis ● Atheroemboli

Liaño F, Pascual J; Kidney Int 1996; 50(3): 811

45 percent 21 percent 13 percent 10 percent 4 percent 2 percent 1 percent

Acute Kidney Injury in Hospital: Associated Conditions

Zeng x et al. Clin J Am Soc Nephrol 2014; 9: 12-20

Acute Kidney Injury: Outcomes

Cerda J et al. Clin J Am Soc Nephrol. 2008; 3:881-886

Chronic Renal Confusion          

Chronic renal failure Chronic renal insufficiency Mild renal insufficiency Moderate chronic renal insufficiency Moderate or advanced renal insufficiency Severe renal insufficiency Renal dysfunction Severe renal dysfunction Decreased renal function Pre–end-stage renal disease

Hsu & Chertow, Am J Kidney Dis p415-418, 2000

         

Low clearance (pre-dialysis) patients Pre-uremic Renal failure Renal disease Renal insufficiency Pre-dialysis Mildly elevated serum creatinine Chronic renal failure patients not on dialysis Pre–end-stage chronic renal failure Mild renal failure

Definition of CKD: KDIGO 2012 (Updated Definition)

KDOQI: Kidney Disease Outcome Quality Initiative KDIGO: Kidney Disease-Improving Global Outcomes

Kidney International Supplements (2013) 3, 5–14 7

GFR: Glomerular Filtration Rate

KDIGO 2012: Staging CGA System (Cause, GFR, Alb.) Low risk

Moderate risk

High risk

Very high risk

Kidney International Supplements (2013) 3, 5–14 7

Renal Disease in DM and HTN

USRDS 2012 report

CKD Risk by Disease State

USRDS 2012 report

Rates of Death and CV Events by eGFR 14.14

40

11.36

10 8 4.76

6 4 2

36.60

35

12

Rate of CV Events†

Rate of Death From Any Cause*

14

0.76

1.08

30 25

21.80

20 15

11.29

10 5

2.11

3.65

0

0 ≥60

45-59

30-44

15-29