Etienne Macedo

Nephrology follow up after AKI episode

Acute kidney injury (AKD) is a prevalent disease affecting 5-10 % of the hospitalized patients worldwide. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, outpatient follow-up with a nephrologist within 90 days of hospital discharge has been associated with enhanced survival. Appropriate management and follow up can enhance the application of treatment strategies to slow the progression of CKD, adequately treat the complications of CKD, treat co-morbidities, and improve the transition to end stage renal disease. Many patients with AKI and CKD are not referred to a nephrologist or they receive late referrals. Nephrologists have been recognized as experts for AKI recovery phase and slowing the progression of CKD. We are currently evaluating the effect of Nephrologist follow up after AKI at UCSD.


Timing of RRT initiation in AKI
Critically ill patients who develop acute kidney injury (AKI) can require dialysis treatment during hospital admission. One potential modifiable factor that could impact the clinical course and outcomes of patients with severe AKI is the timing of initiation of dialytic support. We developed a novel approach to quantify factors that define the need to dialytic support in critically ill patients. This approach is based on the principle that at any given time, the need for renal support depends on the balance between the demand and the renal functional capacity. We identified key factors that contribute to demand and capacity and created a tool to evaluate and express it as a clinical index. Our preliminary data demonstrates this clinical index is strongly associated with the need for renal support. We are currently evaluating the clinical application of the index to support physician’s decision to start dialysis.

Assessment of Filtration and Tubular Biomarkers during an episode of AKI
We are evaluating sequential assessment of filtration and tubular function biomarkers before and during an episode of AKI. We aim to develop a comprehensive assessment of kidney health and determine its correlation of function decline after acute kidney injury.