Tags

Type your tag names separated by a space and hit enter

Renoprevention: A new concept for reengineering nephrology care--an economic impact and patient outcome analysis of two hypothetical patient management paradigms in the CCU.
Ren Fail. 2013; 35(1):23-8.RF

Abstract

BACKGROUND

The impact of acute kidney injury (AKI) on chronic kidney disease (CKD) progression remains uncertain; the common belief is that AKI in CKD is short-lived with subsequent full recovery. However 25.2% of end-stage renal disease (ESRD) Medicare patients all experienced antecedent AKI. We recently described a new syndrome of ESRD following AKI, the syndrome of rapid-onset end-stage renal disease (SORO-ESRD). Renoprevention, which we described in 2009, is the application of preventative measures to reduce AKI incidence.

METHODS

This is a descriptive study based on real clinical experience. Two hypothetical 69-year-old Caucasian male patients, A and B, with symptomatic coronary artery disease (CAD) presented for elective cardiac catheterization and subsequent coronary artery bypass graft procedures; renoprevention was applied in patient A but not in B.

RESULTS

Aggressive fluid repletion, withholding Lisinopril 40 mg once daily (QD) 1 week before hospitalization (hydralazine substituted) in A-earlier discharge after 6 days, transient minimal change in serum creatinine. Patient B continued on Lisinopril 40 mg QD, experienced prolonged hypotension needing pressors-severe oliguric AKI, volume overload, daily RRT for 6 days, recovered kidney function, was discharged after 20 days. Hospital charges were $68,580 (A) versus $154,650 (B). If patient B had developed ESRD (SORO-ESRD), the savings would be humongous.

CONCLUSION

A more forceful and pragmatic application of renoprevention strategies in the coronary care unit (CCU)-preemptive withholding of nephrotoxics including renin angiotensin aldosterone system (RAAS) blockers, aggressive prevention of perioperative hypotension, avoiding nephrotoxic exposure as contrast, and antibiotics-leads to less AKI, potentially less SORO-ESRD, better patient outcomes, and massive dollar savings. Such paradigm shifts would constitute major rethinking in current nephrology practice, a form of nephrology practice reengineering.

Authors+Show Affiliations

College of Medicine, Mayo Clinic, Rochester, MN 54702, USA. onuigbo.macaulay@mayo.edu

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23151177

Citation

Onuigbo, Macaulay A C.. "Renoprevention: a New Concept for Reengineering Nephrology Care--an Economic Impact and Patient Outcome Analysis of Two Hypothetical Patient Management Paradigms in the CCU." Renal Failure, vol. 35, no. 1, 2013, pp. 23-8.
Onuigbo MA. Renoprevention: A new concept for reengineering nephrology care--an economic impact and patient outcome analysis of two hypothetical patient management paradigms in the CCU. Ren Fail. 2013;35(1):23-8.
Onuigbo, M. A. (2013). Renoprevention: A new concept for reengineering nephrology care--an economic impact and patient outcome analysis of two hypothetical patient management paradigms in the CCU. Renal Failure, 35(1), 23-8. https://doi.org/10.3109/0886022X.2012.741644
Onuigbo MA. Renoprevention: a New Concept for Reengineering Nephrology Care--an Economic Impact and Patient Outcome Analysis of Two Hypothetical Patient Management Paradigms in the CCU. Ren Fail. 2013;35(1):23-8. PubMed PMID: 23151177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renoprevention: A new concept for reengineering nephrology care--an economic impact and patient outcome analysis of two hypothetical patient management paradigms in the CCU. A1 - Onuigbo,Macaulay A C, Y1 - 2012/11/15/ PY - 2012/11/16/entrez PY - 2012/11/16/pubmed PY - 2013/7/3/medline SP - 23 EP - 8 JF - Renal failure JO - Ren Fail VL - 35 IS - 1 N2 - BACKGROUND: The impact of acute kidney injury (AKI) on chronic kidney disease (CKD) progression remains uncertain; the common belief is that AKI in CKD is short-lived with subsequent full recovery. However 25.2% of end-stage renal disease (ESRD) Medicare patients all experienced antecedent AKI. We recently described a new syndrome of ESRD following AKI, the syndrome of rapid-onset end-stage renal disease (SORO-ESRD). Renoprevention, which we described in 2009, is the application of preventative measures to reduce AKI incidence. METHODS: This is a descriptive study based on real clinical experience. Two hypothetical 69-year-old Caucasian male patients, A and B, with symptomatic coronary artery disease (CAD) presented for elective cardiac catheterization and subsequent coronary artery bypass graft procedures; renoprevention was applied in patient A but not in B. RESULTS: Aggressive fluid repletion, withholding Lisinopril 40 mg once daily (QD) 1 week before hospitalization (hydralazine substituted) in A-earlier discharge after 6 days, transient minimal change in serum creatinine. Patient B continued on Lisinopril 40 mg QD, experienced prolonged hypotension needing pressors-severe oliguric AKI, volume overload, daily RRT for 6 days, recovered kidney function, was discharged after 20 days. Hospital charges were $68,580 (A) versus $154,650 (B). If patient B had developed ESRD (SORO-ESRD), the savings would be humongous. CONCLUSION: A more forceful and pragmatic application of renoprevention strategies in the coronary care unit (CCU)-preemptive withholding of nephrotoxics including renin angiotensin aldosterone system (RAAS) blockers, aggressive prevention of perioperative hypotension, avoiding nephrotoxic exposure as contrast, and antibiotics-leads to less AKI, potentially less SORO-ESRD, better patient outcomes, and massive dollar savings. Such paradigm shifts would constitute major rethinking in current nephrology practice, a form of nephrology practice reengineering. SN - 1525-6049 UR - https://www.unboundmedicine.com/medline/citation/23151177/Renoprevention:_A_new_concept_for_reengineering_nephrology_care__an_economic_impact_and_patient_outcome_analysis_of_two_hypothetical_patient_management_paradigms_in_the_CCU_ L2 - https://www.tandfonline.com/doi/full/10.3109/0886022X.2012.741644 DB - PRIME DP - Unbound Medicine ER -