Continent specific AKl E urope Asia North american Plenty data Poor area: inadequate data Plenty data Japan, korea, China: data increasing Africa data fallibility Latin American Semin Nephrol. 2008 Jul; 28(4) Nephron Clin Pract. 2008, 109(4) Korean J Intern Med. 2010, 25(2)
Continent specific AKI North American Plenty data Europe Plenty data Africa Complicated ， data fallibility Asia Poor area：inadequate data Japan, korea, China: data increasing Latin American Same as Africa Semin Nephrol. 2008 Jul;28(4) Nephron Clin Pract. 2008,109(4) Korean J Intern Med. 2010, 25(2)
RIFLE Studies Patient populations Criteria used Critically ill ·△ Cr only General Icu △ GFR only ID ICU △ r/GFR+UO ICU treated w rrt Cardiothoracic surgery When AKl was staged Elective abdominal aortic surgery At ICu admit Stroke RIFLE initial Burns RIFLE max BMT At renal consult iver transplant At start of rrt Cirrhosis Pediatric ICU Mortality endpoints Outside the cu ICU Hospital admissions Hospita Population-based 28d,30d,60d,6mo,1yr
RIFLE studies Patient populations • Critically ill – General ICU • ID ICU – ICU treated w RRT – Cardiothoracic surgery – Elective abdominal aortic surgery – Stroke – Burns – BMT – Liver transplant – Cirrhosis – Pediatric ICU • Outside the ICU – Hospital admissions – Population-based Criteria used • Cr only • GFR only • Cr/GFR + UO When AKI was staged • At ICU admit • RIFLE initial • RIFLE max • At renal consult • At start of RRT Mortality endpoints • ICU • Hospital • 28d, 30d, 60d, 6 mo, 1 yr
AKI in hospitalized patients -from published literatures Reference No) Cohort Patients, n AKL, Risk, Injury, Failure, %6 Cruz(14) ICU 2,164 10.8 2.1 3.8 4.9 Heringlake(51) CS-ICU 9,623 16 Uchino(44) Hospital 20,126 18 52 3.7 Kuitunen(43) CS-ICU 813 19.1 108 3.4 Lopes(48) BMT 14 33.5 135 10 143 Lopes(46) Burn 126 35.7 143 8.7 12.7 Ostermann(52) ICU 41,972 35.8 17.2 7.6 o'Riordan(53) Liver Tx 359 35.9 10 Lopes(47) Sepsis 37.4 6.0 11.5 Lopes(45) HⅣV-ICU 47.4 124 9.6 25.8 Ahlstrom(54) ICU 52.0 25.5 152 Guitard(55) Liver tx 94 63.8 NA 41.5 223 Hoste(11) ICU 5383 67 124 26.5 28.1 Lin(56) ICU-ECMO 23.9 Abosaif (57) ICU-AKI Be(15) ICU-RRT 287 86.9 32.8 30.6 23.5 90.8 242 58.5 Maccariello (16) ICU-RRT 214 100 25.0 27.0 48.0 Hoste, et al. Crit Care 2006: Cruz et al. Clin JASM. 2007. Maccariello, et al. Intensive Care Med 2007: Bell, et al. AKI was diagnozed Nephrol Dial Transplant, 2005: Lopes, et al. Crit Care, 2007, Heringlake, et al. Minerva Anestesiol 2006, with rifle criteria Kuitunen, et al. Ann Thorac Surg 2006: Uchino, et al. Crit Care Med 2006: Osterman, et al. Crit Care Med 200 O'Riordan, et al. Crit Care Med 2007, Ahlstrom, et al. AKD, 2006: Guitard, et al. Clin Nephrol, 2006; Lin, et al. Nephrol Dial Transplant, 2006: Lopes, et al. Nephrol Dial Transplant, 2007, Abosaif, et aL. AKD 2005
AKI in hospitalized patients —— from published literatures AKI was diagnozed with RIFLE criteria Hoste, et al. Crit Care 2006; Cruz, et al. Clin JASN, 2007; Maccariello, et al. Intensive Care Med 2007; Bell, et al. Nephrol Dial Transplant, 2005; Lopes, et al. Crit Care, 2007; Heringlake, et al. Minerva Anestesiol 2006; Kuitunen, et al. Ann Thorac Surg 2006; Uchino, et al. Crit Care Med 2006; Osterman, et al. Crit Care Med 2007; O’Riordan , et al. Crit Care Med 2007; Ahlstrom , et al. AJKD, 2006; Guitard, et al. Clin Nephrol, 2006; Lin, et al. Nephrol Dial Transplant, 2006; Lopes, et al. Nephrol Dial Transplant, 2007; Abosaif, et al. AJKD 2005
Epidemiologic studies on AKI Cardiac ICU surgery Medical tervention nephrology Surgery ICU Vascular Cardiac AKI registration systems D AKI cooperative network
Epidemiologic studies on AKI nephrology Cardiac ICU hepatobiliary surgery Vascular surgery Surgery ICU Cardiac surgery Intervention Radiology Medical staffs Dietitian Professional nurse ICU AKI registration systems AKI cooperative network
2004-2008,17,6155 admissions Incidence of aK 3. 19% Ischemia kidney injury Contrast induced nephropathy 27.8 百 百分比% 18.9 比20 13.12 18.53 5.38 9.98 10 1.19 肾后性 肾前+肾性肾性+肾后性肾前+肾后 氨基糖甙类抗生素 Yi Fang, Xiaoqiang Ding, et al. Blood Purification, 2010
Yi Fang, Xiaoqiang Ding, et al. Blood Purification, 2010 2004-2008， 17,6155 admissions Incidence of AKI 3.19% Contrast induced nephropathy Ischemia kidney injury