Disclosures: Macedo reports no relevant financial disclosures.
September 16, 2021
3 min read
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Initiative aims to eliminate preventable deaths from AKI worldwide by 2025

Disclosures: Macedo reports no relevant financial disclosures.
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Two million people die from AKI each year; patients who survive are more likely to have more episodes, published reports indicate.

However, most of those episodes are preventable, an initiative by the International Society of Nephrology (ISN) shows.

“The ‘0 by 25’ initiative aims to eliminate or at least reduce avoidable AKI-related deaths around the world by 2025,” Etienne Macedo, MD, of the department of medicine at University of California, San Diego, and colleagues wrote in a progress report published in Annals of Nutrition and Metabolism.

They identified two points that were essential for the initiative:

  • define preventable deaths from AKI; and
  • promote local recommendations for AKI care considering the health care infrastructure and socioeconomic conditions.

“This initiative is enabling the development of sustainable infrastructure to improve education, training, care delivery and implementation of diagnostic and intervention studies,” the authors wrote. “It provided evidence suggesting that the majority of AKI cases would be treatable and often reversible, with early identification in high-risk patients and implementation of basic treatment.”

The ISN launched the following three projects associated with the “0 by 25” initiative:

  • a meta-analysis of AKI epidemiology around the world;
  • a Global AKI Snapshot study, which provided insights into the recognition, treatment and outcomes of AKI worldwide; and
  • a pilot project designed to test whether education and a simple protocol-based approach can improve outcomes.

“Although knowledge of the epidemiology of AKI has improved immensely since the use of a standardized AKI classification system, few studies have focused on community-acquired AKI in low-resource settings,” Macedo and colleagues wrote.

Etienne Macedo

A key step in reducing the risk of AKI is identifying the early warning signs.

“ … [T]o reduce AKI-related mortality and morbidity, knowledge of the factors that affect AKI outcomes is a key step in implementing initiatives,” the authors wrote.

“The strategies to reduce the burden of AKI need to be based on the identification of patients at risk, implementation of preventive actions, application of diagnostic methods and timely referral for specialist care.”

As part of the “0 by 25” initiative, the ISN is conducting a Kidney Care Network project to assess whether a successful intervention from its pilot feasibility study can become routine health care in low- and middle-income countries and achieve sustainable, locally led improvement in AKI detection and management. The Kidney Care Network is being carried out across four project sites in Bolivia, Brazil, South Africa and Nepal.

Macedo and colleagues detailed progress on the project in a paper published earlier this year.

“We used a comprehensive 5R approach – risk, recognition, response, renal support and rehabilitation – to test the intervention in resource-constrained regions in Africa, Asia, and Latin America,” the authors wrote. “Patients seen in community health care centers were screened and assigned a risk level for AKI based on their presenting signs and symptoms. Patients with moderate to high risk were approached for consent and enrolled in the study, underwent kidney function assessment, and were followed for their disposition and outcomes.”

Point-of-care (POC) tests were used to determine kidney function; the tests included a test strip for measuring creatinine level in the blood and a urine dipstick test to evaluate for proteinuria.

“The ISN ‘0 by 25’ trial successfully demonstrated the utility of a symptom-based health assessment risk score coupled with a POC creatinine and urine dipstick test in early recognition of kidney disease and appropriate triaging and management of patients presenting to primary health care centers in low- income countries,” the authors said. “Kidney dysfunction was associated with an increased risk of mortality, which was higher in patients with a moderate severity of AKI.”

Macedo said the ISN efforts are helping to provide better tools to manage AKI.

“I think we are slowly making progress,” Macedo told Nephrology News & Issues. “We must focus on education and training in AKI care to improve the standard of care in AKI detection and management in a way that is appropriate to and sustainable within the local setting.”