Early Nephrologist Interventions to Avoid Kidney Replacement Therapy in AKI

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Background: Is well know that early nephrologist involvement in patients with AKI improve outcomes. Determine which intervention has a greater impact on avoiding the need for KRT will be an important advance. Methods: Our objective was to Identify which nephrologist intervention decrease the need of KRT. We analyze age, gender, comorbid conditions, cause of AKI, pharmacology therapy, cause of KRT, early interventions: fluid, antibiotic and nutritional adjustment, nephrotoxic withdrawal and removal of hyperchloremic solutions and death. Kaplan Meier survival analysis. Multivariable logistic regression model was performed. P< 0.05 which is significant. Results: From 2017 to 2020 288 patients with AKI where analyzed prospectively with a 10 days follow-up, 45 (15%) patients die, overall survival of 84.4% (IC 95% 0.80 - 0.88) (Figure1). Only fluid adjustment decreases the risk of KRT (OR 0.74, 95% CI 0.68-0.81, p < 0.001) while having AKI KDIGO 3 increases the risk (OR 1.12, 95% CI 1.05-1.20, p < 0.001) being the fluid overload the main cause of KRT (OR 1.67, 95% CI 1.53-1.82, p < 0.001). Between all interventions, just fluid adjustment avoid progression to AKI KDIGO 3 (OR 0.76, 95% CI 0.65-0.89, p < 0.001). (Table1) Conclusions: In AKI, fluid adjustment was the most important nephrologist intervention to avoid KRT. - Variable OR 95% CI p KDIGO 3 1.12 1.05 1.20 <0.001 KDIGO 1 1.03 0.95 1.12 0.35 Age 0.99 0.99 1.00 0.06 DM 0.99 0.93 1.07 0.98 HAS 0.96 0.89 1.02 0.24 CKD 0.97 0.90 1.03 0.36 NSAIDs 0.98 0.93 1.04 0.60 Vasopressors 0.94 0.87 1.02 0.17 Sepsis 1.02 0.96 1.09 0.43 Hypovolemia 0.97 0.91 1.04 0.54 Cardiorenal syndrome 0.94 0.85 1.04 0.31 Nephrotoxic drugs 1.00 0.92 1.08 0.95 Shock 1.05 0.97 1.13 0.21 Nephrotoxic withdrawal 0.94 0.88 1.01 0.12 Liquid adjustment 0.74 0.68 0.81 <0.001 Antibiotic adjustment 1.02 0.95 1.11 0.45 Nutritional adjustment 0.97 0.82 1.15 0.79 Removal of hyperchloremic solutions 0.91 0.80 1.04 0.19 RRT due to acid base disorders 1.13 1.01 1.27 <0.001 RRT due to fluid overload 1.67 1.52 1.82 <0.001 RRT due to Uremia 1.31 1.19 1.45 <0.001

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