Nationwide epidemiology and prognosis of dialysis-requiring acute kidney injury (NEP-AKI-D) study: Design and methods.

AIM: Acute kidney injury (AKI) carries an increasing incidence rate worldwide and increases the risk of developing end-stage renal disease (ESRD) as well as the medical expenses during the post-AKI course. The Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs) has thus launched a nationwide epidemiology and prognosis of dialysis-requiring acute kidney injury (NEP-AKI-D) study, which prospectively enrols critically ill patients with AKI. Through thoroughly evaluating the risk and prognostic factors of AKI, we hope to lower the incidence of AKI and ESRD from the perspective of AKI-ESRD interaction. METHODS: The CAKs includes 30 hospitals which distribute widely through the four geographical regions (north, middle, south, and east) of Taiwan, and have a 1:1 ratio of medical centres to regional hospitals in each region. The NEP-AKI-D study enrols intensive care unit-based AKI patients who receive dialysis in the four seasonal sampled months (October 2014, along with January, April, and July 2015) in the included hospitals. The collected data include demographic information, pertaining laboratory results, dialysis settings and patient outcomes. The data are uploaded in a centre website and will be audited by on-site principal investigators, computer logic gates, and the CAKs staffs. The outcomes of interest are in-hospital mortality, dialysis-dependency and readmission rate within 90 days after discharge. CONCLUSION: The NEP-AKI-D study enrols a large number of representative AKI patients throughout Taiwan. The results of the current study are expected to provide more insight into the risk and prognostic factors of AKI and further attenuated further chronic kidney disease transition.

Long-term online hemodiafiltration does not reduce the frequency and severity of acquired cystic kidney disease in hemodialysis patients.

BACKGROUND: Acquired cystic kidney disease (ACKD) is a frequent complication in chronic hemodialysis (HD) patients and a risk factor for renal cell carcinoma. Online hemodiafiltration (HDF) provides better clearance of middle molecular weight solutes, but its effect on ACKD has not been investigated. MATERIALS AND METHODS: This case-control study enrolled 86 patients (43 HDF patients and 43 HD patients) who were matched according to age, sex, and duration of renal replacement therapy. The mean duration of HDF was 63 (+/- 35) months. The frequency and severity of ACKD was evaluated by ultrasonography using a severity scoring system. RESULTS: We observed ACKD in 23 of the HD patients (53.5%) and 21 of the HDF patients (48.8%). This difference was not statistically significant (p = 0.829). The overall ACKD severity scores were similar in the two groups (p = 0.875). Patients on HDF had significantly lower serum levels of alkaline phosphatase and intact parathyroid hormone. Multiple logistic regression analysis indicated that duration of renal replacement therapy was the only risk factor for the presence of ACKD (p < 0.001). There was a significant correlation between duration of renal replacement therapy and ACKD severity score (r = 0.589, p < 0.001). CONCLUSIONS: Our results suggest that long-term online HDF does not reduce the frequency and severity of ACKD in dialysis patients. Duration of renal replacement therapy is the most important risk factor for ACKD. Factors that cannot be corrected by use of HDF may contribute to the formation of renal cysts.