Background: Acute kidney injury (AKI) is a complex syndrome associated with substantial morbidity, mortality and costs. Despite advancements in diagnosis and care practice, AKI remains a disorder usually under/late-recognized with high mortality. One of the hidden reasons for poor outcome might be delayed nephrology consultation, with the involvement of the specialist only in severe stages of AKI when renal replacement therapy (RRT) is required. Methods: We searched PubMed, EMBASE and Cochrane central register for related work on the subject. Six studies were identified for the meta-analysis, correlating time of nephrology consultation and mortality in AKI. Results: We found that delayed nephrology consultation is associated with higher mortality in AKI, with an OR 0.79 (95% CI 0.48-1.10, p < 0.05). Conclusion: Delayed nephrology consultation contributes to higher mortality in AKI. The early involvement of nephrologist may present an advantage in terms of early recognition, prevention and effective treatment of AKI. An early involvement of multidisciplinary task force may contribute to better treatment, before the preventable complications of AKI occur or an emergency RRT is required.

1.
Bellomo R, Ronco C: Acute renal failure in the intensive care unit: adequacy of dialysis and the case for continuous therapies. Nephrol Dial Transplant 1996;11:424-428.
2.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P: Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-R212.
3.
Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, Bagshaw SM: A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 2011;15:R72.
4.
Gaudry S, Hajage D, Schortgen F, et al; AKIKI Study Group: Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 2016;375:122-133.
5.
Schneider AG, Bellomo R, Bagshaw SM, et al: Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 2013;39:987-997.
6.
Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T: Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 2005;9:R700-R709.
7.
Gibney N, Hoste E, Burdmann EA, Bunchman T, Kher V, Viswanathan R, Mehta RL, Ronco C: Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions. Clin J Am Soc Nephrol 2008;3:876-880.
8.
Mehta RL, McDonald B, Gabbai F, Pahl M, Farkas A, Pascual MT, Zhuang S, Kaplan RM, Chertow GM: Nephrology consultation in acute renal failure: does timing matter? Am J Med 2002;113:456-461.
9.
Bagshaw SM, George C, Bellomo R; ANZICS Database Management Committe: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569-1574.
10.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.
11.
Perez-Valdivieso JR, Bes-Rastrollo M, Monedero P, de Irala J, Lavilla FJ: Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study. BMC Nephrol 2007;8:14.
12.
Ponce D, Zorzenon Cde P, dos Santos NY, Balbi AL: Early nephrology consultation can have an impact on outcome of acute kidney injury patients. Nephrol Dial Transplant 2011;26:3202-3206.
13.
Balasubramanian G, Al-Aly Z, Moiz A, Rauchman M, Zhang Z, Gopalakrishnan R: Early nephrologist involvement in hospital-acquired acute kidney injury: a pilot study. Am J Kidney Dis 2011;57:228-234.
14.
Costa e Silva VT, Liaño F, Muriel A, Díez R, de Castro I, Yu L: Nephrology referral and outcomes in critically ill acute kidney injury patients. PLoS One 2013;8:e70482.
15.
Flores-Gama C, Merino M, Baranda F, Cruz DN, Ronco C, Vazquez-Rangel A: The impact of integrating nephrologists into the postoperative cardiac intensive care unit: a cohort study. Cardiorenal Med 2013;3:79-88.
16.
Viechtbauer W: Conducting meta-analyses in R with the metafor package. J Stat Softw 2010;36:1-48.
17.
R Core Team: A Language and Environment for Statistical Computing. Vienna, R Foundation for Statistical Computing, 2016.
18.
DerSimonian R, Kacker R: Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 2007;28:105-114.
19.
von Hippel PT: The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med Res Methodol 2015;15:35.
20.
Ronco C, Kellum JA, Haase M: Subclinical AKI is still AKI. Crit Care 2012;16:313-316.
21.
Camussi G, Ronco C, Montrucchio G, Piccoli G: Role of soluble mediators in sepsis and renal failure. Kidney Int Suppl 1998;66:S38-S42.
22.
Goldstein SL, Chawla LS: Renal angina. Clin J Am Soc Nephrol 2010;5:943-949.
23.
Cruz DN, Ferrer-Nadal A, Piccinni P, Goldstein SL, Chawla LS, Alessandri E, Belluomo Anello C, Bohannon W, Bove T, Brienza N, Carlini M, Forfori F, Garzotto F, Gramaticopolo S, Iannuzzi M, Montini L, Pelaia P, Ronco C; NEFROINT Investigators: Utilization of small changes in serum creatinine with clinical risk factors to assess the risk of AKI in critically ill adults. Clin J Am Soc Nephrol 2014;9:663-672.
24.
Liu KD, Matthay MA, Chertow GM: Evolving practices in critical care and potential implications for management of acute kidney injury. Clin J Am Soc Nephrol 2006;1:869-873.
25.
Cruz DN, Perazella MA, Bellomo R, Corradi V, de Cal M, Kuang D, et al: Extracorporeal blood purification therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Kidney Dis 2006;48:361-371.
26.
Chawla LS, Eggers PW, Star RA, Kimmel PL: Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 2014;371:58-66.
27.
Sharma A, Mucino MJ, Ronco C: Renal functional reserve and renal recovery after acute kidney injury. Nephron Clin Pract 2014;127:94-100.
28.
Ronco C, Rosner MH: Acute kidney injury and residual renal function. Crit Care 2012;16:144.
29.
Ronco C, Bellomo R: Critical care nephrology: the time has come. Nephrol Dial Transplant 1998;13:264-267.
30.
Vincent JL: Critical care nephrology: a multidisciplinary approach. Contrib Nephrol 2007;156:24-31.
31.
Levin A, Warnock DG, Mehta RL, Kellum JA, Shah SV, Molitoris BA, et al: Improving outcomes from acute kidney injury: report of an initiative. Am J Kidney Dis 2007;50:1-4.
32.
Levy EM, Viscoli CM, Horwitz RI: The effect of acute renal failure on mortality. A cohort analysis. JAMA 1996;275:1489-1494.
33.
Yap SC, Lee HT: Acute kidney injury and extrarenal organ dysfunction: new concepts and experimental evidence. Anesthesiology 2012;116:1139-1148.
34.
Singbartl K, Kellum JA: AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012;81:819-825.
35.
Ronco C, Bellomo R: Acute renal failure and multiple organ dysfunction in the ICU: from renal replacement therapy (RRT) to multiple organ support theraphy. Int J Artif Organs 2002;25:733-747.
36.
Bellomo R, Ronco C: Blood purification in the intensive care unit: evolving concepts. World J Surg 2001;25:677-683.
37.
Ronco C, Brendolan A, Dan M, Piccinni P, Bellomo R, De Nitti C, et al: Adsorption in sepsis. Kidney Int Suppl 2000;76:S148-S155.
38.
Ronco C, Costanzo MR, Bellomo R, Maisel AS (eds): Fluids Overload: Diagnosis and Management. Contrib Nephrol. Basel, Karger, 2010, vol 164, pp I-VIII.
39.
Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL; Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators: A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008;12:R74.
40.
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R: Cardiorenal syndrome. J Am Coll Cardiol 2008;52:1527-1539.
41.
Ronco C, Brendolan A, Bragantini L, Chiaramonte S, Feriani M, Fabris A, et al: Treatment of acute renal failure in newborns by continuous arterio-venous hemofiltration. Kidney Int 1986;29:908-915.
42.
Ronco C, Brendolan A, Crepaldi C, Rodighiero M, Scabardi M: Blood and dialysate flow distributions in hollow-fiber hemodialyzers analyzed by computerized helical scanning technique. J Am Soc Nephrol 2002;13(suppl 1):S53-S61.
43.
Alves SC, Tomasi CD, Constantino L, Giombelli V, Candal R, Bristot Mde L, Topanotti MF, Burdmann EA, Dal-Pizzol F, Fraga CM, Ritter C: Hypomagnesemia as a risk factor for the non-recovery of the renal function in critically ill patients with acute kidney injury. Nephrol Dial Transplant 2013;28:910-916.
44.
Santos MS, Seguro AC, Andrade L: Hypomagnesemia is a risk factor for nonrecovery of renal function and mortality in AIDS patients with acute kidney injury. Braz J Med Biol Res 2010;43:316-323.
45.
Campos SB, Silva JC, Seguro AC: Hypomagnesemia potentiates postischemic acute renal failure. J Am Soc Nephrol 2001;12:4057.
46.
Kellum JA, Singer M, Webb A (eds): Oxford American Handbook of Critical Care. New York, Oxford University Press, 2008, vol 82, pp 107-110; 125-128; 347-403.
47.
Mitchell JH, Wildenthal K, Johnson RL Jr: The effects of acid-base disturbances on cardiovascular and pulmonary function. Kidney Int 1972;1:375-389.
48.
Kraut JA, Madias NE: Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol 2012;8:589-601.
49.
Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ: Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol 2007;3:138-153.
50.
Fiaccadori E, Maggiore U, Cabassi A, Morabito S, Castellano G, Regolisti G: Nutritional evaluation and management of AKI patients. J Ren Nutr 2013;23:255-258.
51.
McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine: Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr 2009;33:277-316.
52.
Bellomo R, Ronco C: How to feed patients with renal dysfunction. Curr Opin Crit Care 2000;6:239-246.
53.
Bagshaw SM, Bellomo R, Kellum JA: Oliguria, volume overload, and loop diuretics. Crit Care Med 2008;36(4 suppl):S172-S178.
54.
DePriest J: Reversing oliguria in critically ill patients. Postgrad Med 1997;102:245-246, 251-252, 258 passim.
55.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL: Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354:2564-2575.
56.
Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP: Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 2009;76:422-427.
57.
Frangiosa A, De Santo LS, Anastasio P, De Santo NG: Acid-base balance in heart failure. J Nephrol 2006;19(suppl 9):S115-S120.
58.
Peixoto AJ, Alpern RJ: Treatment of severe metabolic alkalosis in a patient with congestive heart failure. Am J Kidney Dis 2013;61:822-827.
59.
Bellomo R, Ronco C (eds): Nomenclature for Continuous Renal Replacement Therapies. Critical Care Nephrology. Netherlands, Springer, 1998, pp 1169-1176.
60.
Anderson LE, Henrich WL: Alkalemia-associated morbidity and mortality in medical and surgical patients. South Med J 1987;80:729-733.
61.
Fall P, Szerlip HM: Continuous renal replacement therapy: cause and treatment of electrolyte complications. Semin Dial 2010;23:581-585.
62.
Adrogue HJ, Rashad Mn, Gorin AB, Yacoub J, Madias NE: Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. N Engl J Med 1989;320:1312-1316.
63.
Posner JB, Plum F: Spinal-fluid pH and neurologic symptoms in systemic acidosis. N Engl J Med 1967;277:605-613.
64.
Hood VL, Tannen RL: Protection of acid-base balance by pH regulation of acid production. N Engl J Med 1998;339:819-826.
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