Prevention of acute kidney injury using vasoactive or antiplatelet treatment: Three strikes and out?

摘要

Acute kidney injury (AKI) is a serious complication of surgery and other severe health events (eg, sepsis). Its most severe form, AKI requiring dialysis, occurred during almost 164 000 hospitalizations in the United States in 2009 and was associated with almost 39 000 deaths. The incidence of AKI has been increasing substantially over the past decade, by 7% per year even after adjustment for changes in case mix. The in-hospital mortality rate associated with AKI requiring dialysis was approximately 25% for all cases, and even higher (35%) in patients undergoing cardiac surgery. In cardiac surgery, the population-attributable fraction (ie, the excess event rate or risk fraction for the outcome estimated to be potentially "attributable" to the exposure) of in-hospital mortality was almost 50% for all AKI, and 14% for AKI requiring dialysis. The costs associated with AKI are substantial and impose a significant burden on the health care system.