scholarly journals A Review on the Application and Limitations of Administrative Health Care Data for the Study of Acute Kidney Injury Epidemiology and Outcomes in Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Emma H. Ulrich ◽  
Gina So ◽  
Michael Zappitelli ◽  
Rahul Chanchlani
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Administrative Data ◽  
Health Research ◽  
Validation Studies ◽  
Large Scale ◽  
Kidney Injury ◽  
Process Of Care ◽  
Data Repositories ◽  
Adults And Children

Administrative health care databases contain valuable patient information generated by health care encounters. These “big data” repositories have been increasingly used in epidemiological health research internationally in recent years as they are easily accessible and cost-efficient and cover large populations for long periods. Despite these beneficial characteristics, it is also important to consider the limitations that administrative health research presents, such as issues related to data incompleteness and the limited sensitivity of the variables. These barriers potentially lead to unwanted biases and pose threats to the validity of the research being conducted. In this review, we discuss the effectiveness of health administrative data in understanding the epidemiology of and outcomes after acute kidney injury (AKI) among adults and children. In addition, we describe various validation studies of AKI diagnostic or procedural codes among adults and children. These studies reveal challenges of AKI research using administrative data and the lack of this type of research in children and other subpopulations. Additional pediatric-specific validation studies of administrative health data are needed to promote higher volume and increased validity of this type of research in pediatric AKI, to elucidate the large-scale epidemiology and patient and health systems impacts of AKI in children, and to devise and monitor programs to improve clinical outcomes and process of care.

scholarly journals Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease

2019 ◽  
Vol 6 ◽  
pp. 205435811988018 ◽  
Author(s):  
Erin Hessey ◽  
Sylvie Perreault ◽  
Marc Dorais ◽  
Louise Roy ◽  
Michael Zappitelli
Keyword(s):  
Health Care ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Renal Disease ◽  
Critically Ill ◽  
Administrative Data ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Post Discharge

Background: The progression from acute kidney injury (AKI) to chronic kidney disease (CKD) is not well understood in children. Objectives: We aimed to develop a pediatric CKD definition using administrative data and use it to evaluate the association between AKI in critically ill children and CKD 5 years after hospital discharge. Design: Retrospective cohort study using chart collection and administrative data. Setting: Two-center study in Montreal, Canada. Patients: Children (≤18 years old) admitted to two pediatric intensive care units (ICUs) between 2003 and 2005. We a priori excluded patients with end-stage renal disease or no health care number. Only the first admission during the study period was included. We excluded patients who could not be linked to administrative data, did not survive hospitalization, or had preexisting renal disease. Measurements: Acute kidney injury was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were defined as having CKD 5 years post-discharge if they had ≥1 CKD diagnostic code or ≥1 CKD-specific medication prescription. Methods: Chart data used to define the exposure (AKI) were merged with provincial administrative data used to define the outcome (CKD). Cox regression was used to evaluate the AKI-CKD association. Results: A total of 2235 (56% male) patients were included, and the median admission age was 3.7 years. A total of 464 (21%) patients developed AKI during pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively ( P < .001). Limitations: Results may not be generalizable to non-ICU patients. We were not able to control for post-discharge variables; future research should try to explore these additional potential risk factors further. Conclusions: Acute kidney injury is associated with 5-year post-discharge CKD diagnosis defined by administrative health care data.

scholarly journals Reproducible Large-Scale Isolation of Exosomes from Adipose Tissue-Derived Mesenchymal Stem/Stromal Cells and Their Application in Acute Kidney Injury

2020 ◽  
Vol 21 (13) ◽  
pp. 4774 ◽  
Author(s):  
Jun Ho Lee ◽  
Dae Hyun Ha ◽  
Hyeon-kyu Go ◽  
Jinkwon Youn ◽  
Hyun-keun Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Adipose Tissue ◽  
Stromal Cells ◽  
Large Scale ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Preclinical Studies ◽  
Scale Production ◽  
Positive Effects ◽  
Large Scale Production

Acute kidney injury (AKI) is a fatal medical episode caused by sudden kidney damage or failure, leading to the death of patients within a few hours or days. Previous studies demonstrated that exosomes derived from various mesenchymal stem/stromal cells (MSC-exosomes) have positive effects on renal injuries in multiple experimental animal models of kidney diseases including AKI. However, the mass production of exosomes is a challenge not only in preclinical studies with large animals but also for successful clinical applications. In this respect, tangential flow filtration (TFF) is suitable for good manufacturing practice (GMP)-compliant large-scale production of high-quality exosomes. Until now, no studies have been reported on the use of TFF, but rather ultracentrifugation has been almost exclusively used, to isolate exosomes for AKI therapeutic application in preclinical studies. Here, we demonstrated the reproducible large-scale production of exosomes derived from adipose tissue-derived MSC (ASC-exosomes) using TFF and the lifesaving effect of the ASC-exosomes in a lethal model of cisplatin-induced rat AKI. Our results suggest the possibility of large-scale stable production of ASC-exosomes without loss of function and their successful application in life-threatening diseases.

scholarly journals Community Health Care Quality Standards to Prevent Acute Kidney Injury and Its Consequences

2020 ◽  
Vol 133 (5) ◽  
pp. 552-560.e3 ◽  
Author(s):  
Samuel A. Silver ◽  
Mitra K. Nadim ◽  
Donal J. O'Donoghue ◽  
Francis P. Wilson ◽  
John A. Kellum ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Community Health ◽  
Health Care Quality ◽  
Kidney Injury ◽  
Quality Standards ◽  
Care Quality ◽  
Community Health Care

Loop diuretics for acute kidney injury in adults and children

2012 ◽  
Author(s):  
Watanyu Parapiboon ◽  
Chavasak Kanokkantapong ◽  
Malinee Laopaiboon ◽  
Pisake Lumbiganon ◽  
Apichat Sangchan
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Loop Diuretics ◽  
Adults And Children

scholarly journals P0619POINT OF CARE CREATININE FOR EARLY DIAGNOSIS OF COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN NIGERIA. TECHNOLOGY EVALUATION AND DESIGN OF QUALITY IMPROVEMENT PROJECT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dimitrios Poulikakos ◽  
Ibi Erekosima ◽  
Pedro Emem-Chioma ◽  
Prelador Fakrogha ◽  
R I Oko-Jaja ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Primary Health Care ◽  
Early Diagnosis ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Kidney Injury ◽  
Improvement Project ◽  
Primary Health ◽  
Port Harcourt

Abstract Background and Aims Acute Kidney Injury (AKI) in low- and middle-income countries is mostly a community-acquired potentially reversible syndrome and has high morbidity and mortality. Due to limited laboratory infrastructure diagnosis of AKI is often delayed until life threatening complications have developed and dialysis treatment is largely unavailable. Decisions for hospital referral from primary health care centers and triage decisions for hospital admission are not based on laboratory results in Port Harcourt Nigeria. To address the need for early diagnosis and treatment of AKI we established a collaboration between the Renal Unit of the University of Port Harcourt Teaching Hospital, Primary Health Care Board Rivers State and the Renal Department of Salford Royal NHS Foundation Trust, aiming at the evaluation of the use of point of care (POC) Creatinine (Cr) for early detection and management of community acquired AKI. Method The first stage of the project evaluated the accuracy of POC Cr technology. Following informed consent patients underwent concurrent measurement of Cr using the central laboratory (Lab) assay (Jaffe) from a venous sample and a point of care Cr measurement using a capillary sample (fingerstick) with the NOVA Stasensor Xpress Cr analyser. Pearson Correlation and Bland-Altman plots were used to assess correlation and agreement between the two methods. During the second stage, the results were discussed at a focused AKI workshop and guidance for the use of POC Cr was developed. Results During the first phase 96 concurrent POC Cr capillary and venous Lab Cr samples were analysed. Mean age was 49±14 years and 66 subjects were females. POC Cr values were 127±122 umol/l and Lab Cr values were 100 ±85 umol/L, mean positive bias of 27.2±47.94 umol/L. Overall, correlation between POC Cr and Lab Cr was very good, with Pearson correlation r=0.956) Figure 1A. All 4 out of 96 values that were outside the limits of agreement (set at mean ±2 standard deviations) were for Lab Cr values &gt;200 umol/L. A Bland-Altman Plot is presented for paired samples with Lab Cr values &lt;200 umol/L (Figure 1B).

Use of Insurance Claims Data in Measuring Quality of Care

1990 ◽  
Vol 6 (2) ◽  
pp. 263-271 ◽  
Author(s):  
Kathleen N. Lohr
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Administrative Data ◽  
Claims Data ◽  
Outcome Analysis ◽  
Process Of Care ◽  
Service Information ◽  
Insurance Claims Data ◽  
Data Banks

AbstractThis article discusses data that might be used for measuring quality of care, for health care administrative purposes, and for tracking the use of technologies. The advantages and limitations of administrative data banks for research purposes and some process-of-care and outcome analysis are noted. Three important obstacles to their use—reliability of diagnosis and service information, unique patient identifiers, and provider identifiers—are discussed briefly.

scholarly journals Development of an Immunoassay for the Kidney-Specific Protein myo-Inositol Oxygenase, a Potential Biomarker of Acute Kidney Injury

2014 ◽  
Vol 60 (5) ◽  
pp. 747-757 ◽  
Author(s):  
Joseph P Gaut ◽  
Dan L Crimmins ◽  
Matt F Ohlendorf ◽  
Christina M Lockwood ◽  
Terry A Griest ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Large Scale ◽  
Kidney Tissue ◽  
Kidney Injury ◽  
Specific Protein ◽  
Creatinine Concentration ◽  
Potential Biomarker ◽  
Mouse Tissues

Abstract BACKGROUND Acute kidney injury (AKI) affects 45% of critically ill patients, resulting in increased morbidity and mortality. The diagnostic standard, plasma creatinine, is nonspecific and may not increase until days after injury. There is significant need for a renal-specific AKI biomarker detectable early enough that there would be a potential window for therapeutic intervention. In this study, we sought to identify a renal-specific biomarker of AKI. METHODS We analyzed gene expression data from normal mouse tissues to identify kidney-specific genes, one of which was Miox. We generated monoclonal antibodies to recombinant myo-inositol oxygenase (MIOX) and developed an immunoassay to quantify MIOX in plasma. The immunoassay was tested in animals and retrospectively in patients with and without AKI. RESULTS Kidney tissue specificity of MIOX was supported by Western blot. Immunohistochemistry localized MIOX to the proximal renal tubule. Serum MIOX, undetectable at baseline, increased 24 h following AKI in mice. Plasma MIOX was increased in critically ill patients with AKI [mean (SD) 12.4 (4.3) ng/mL, n = 42] compared with patients without AKI [0.5 (0.3) ng/mL, n = 17] and was highest in patients with oliguric AKI [20.2 (7.5) ng/mL, n = 23]. Plasma MIOX increased 54.3 (3.8) h before the increase in creatinine. CONCLUSIONS MIOX is a renal-specific, proximal tubule protein that is increased in serum of animals and plasma of critically ill patients with AKI. MIOX preceded the increases in creatinine concentration by approximately 2 days in human patients. Large-scale studies are warranted to further investigate MIOX as an AKI biomarker.

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

2014 ◽  
Vol 4 (3) ◽  
pp. 159-166 ◽  
Author(s):  
J. K. Schaffzin ◽  
C. N. Dodd ◽  
H. Nguyen ◽  
A. Schondelmeyer ◽  
S. Campanella ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Administrative Data ◽  
Kidney Injury ◽  
Hospitalized Children
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