Introduction:
Acute kidney injury (AKI) defined as an abrupt (within hours) decrease in kidney function, which encompasses structural damage as well as loss of function. Each AKI case is associated with considerable mortality and long-term adverse outcomes like cardiovascular complications, chronic kidney disease and others. The majority of AKI episodes are treated conservatively but in quite big group renal replacement therapy (RRT) Number of AKI episodes rapidly grow worldwide and needs for RRT grow in parallel. The most common therapeutic practice with AKI patients needed RRT in Poland is referral to closest dialysis center for intermittent HD/HDF treatment or continuous renal replacement therapy (CRRT) available in ICUs and other hospital wards.
The goal of this study is current clinical practice in country assessment as well as different therapeutic options frequency comparison.
Methods:
Data regarding dialysis provided in Fresenius Nephrocare Poland for patients with AKI (N.17 according to ICD-10 classification) have been extracted from internal monthly reports.
Additionally the number of CRRTs provided country wide has been extracted from Fresenius Medical Care Poland internal reports.
Additionally data from private dialysis network have been compared with data from public university hospital providing RRT for patients with AKI.
Results:
In years 2019-2024 in Fresenius Nephrocare Poland dialysis centers 8368 patients with AKI have been treated. After significant (-20%) drop down in 2020 (first wave of COVID-19 pandemic) the continuous growth (+10%) of AKI patients treated with RRT has been observed. Patients with AKI accounted for about 3% of population treated in Fresenius Nephrocare Poland dialysis centers. Number of treatments provided to patients with N.17 diagnosis didn’t exceed 1% of total RRTs.
For the contrary – public university hospital provided in years 2019-2023 13524 acute RRTs (22% of treatments in this center) including 2918 treatments in SLED mode. The growth of acute treatments in 5 consecutive analyzed years reached 33%.
At the same time hospitals provided CRRT treatments for 142483 AKI patients with 20% growth in years 2019-2024. The most dynamic growth of CRRT treatments number has been observed during COVID-19 outbreak due to limited access to ambulatory dialysis centers. In 2020 the growth of CRRTs reached 12% comparing to 2019.
There were no cases of AKI treatment with peritoneal dialysis in Poland in observed period.
Conclusions:
Figures presented above shows that CRRT is the leading method of RRT in patients with AKI. Dialysis centers working in ambulatory mode, due to organizational limitations provide significantly less dialysis for AKI patients than public dialysis center working in 24/7 mode. Current model of care seems to secure all AKI patients needed RRT and guarantee proper care and optimal resources usage.
I have potential conflict of interest to disclose.
Fresenius Medical Care employee
I did not use generative AI and AI-assisted technologies in the writing process.