Nephrologist and ICU: the need of new expertise

Abstract

Episodes of dialytic Acute Kidney Injury (AKI stage III KDIGO) can lead to chronic kidney disease (CKD), even after a long time. Prelimary data indicate that the relationship between AKI and CKD is affected by dialysis technical modalities and factors in part modifiable, such as an early dialysis timing, dose adeguacy, continuous treatment, use of biocompatible membranes and regional citrate anticoagulation. However, in most ICUs involvement of nephrologist consultant is marginal. Of more, nephrological follow-up after discharge, which allows to slow down the progression rate of CKD even just by a correct pharmacological and dietetic approach (sartans, ACEis), is an uncommon practice. Indeed, a better organ survival could lead to a delay of the dialytic treatment, reducing the costs sustained by the National Health Service.  To face such challenges locally, in Piedmont and Aosta Valley the Dialysis Units were required to put themselves at disposal for ICU needs both in terms of dedicated staff and resources. Additionally, since many years consultant nephrologists have established the “Acuti” work-group, which has been able to provide an high level of professional expertise, while incentivizing innovation and training in ICU environment. In order to cope with these new requirements a redefinition of the nephrologist’s role in ICU through a constant exchange with the intensive care background is needed.

Key words: Acute kidney injury., Critical Care nephrology, Organization, Work group

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