The Face of Acute Kidney Injury. (Published with permission).
It ain’t pretty, it’s Acute Kidney Injury. This case was probably brought on by leptospirosis. This is the face of a well known New Zealander. Do you recognise him? He’s kindly lent his name to my research on AKI. I will reveal that name in future posts as I tell his remarkable story.
Tagged: Acute Kidney Injury, Acute Renal Failure, AKI, ARF, health, hospital, Kidney Attack, leptospirosis 
If this doesn’t scare you, you are an Ostrich. Otago University researcher Dr Kirsten Coppell has released new data on the prevalence of diabetes in New Zealand. See here for the press release.
Basic data:
For those interested in reading the research, it can be found in the NZ Medical Journal. NZMJ 1 March 2013, Vol 126 No 1370; ISSN 1175 8716 URL: http://journal.nzma.org.nz/journal/126-1370/5555/ Dr Coppell kindly sent me a copy (*I’ve made a few more observations about the details of the study for those who are interested below).
In the meantime, this is rightly hitting the headlines. We should be afraid, very afraid. Our politicians must stop arguing over that which is petty (like selling less than half of a small fraction of our assets) and get focussed on what matters. Next year is election year – we should demand a comprehensive diabetes policy from each political party. Below is a letter I wrote to the Christchurch Press prior to the last election – not much has changed. As for you – you can stop attacking the sugar – you don’t need it and it may kill you. Beware of “fat free” food which substitutes sugar instead. Get some advice – see your doctor. Don’t become a statistic in the next survey.
As for the link with my work (Kidney Attack a.k.a. Acute Kidney Injury), the little diagram explains.
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* The study was a representative sample of New Zealanders. The study size was large (for an NZ study) – 4,721.
From the results
Overall the prevalence of diabetes was 7.0% (95% CI: 6.0, 8.0). Diabetes was more common among men (8.3%; 95% CI: 6.4, 10.1) compared with women (5.8%; 95% CI: 4.7, 7.0). The prevalence of diagnosed diabetes was 6.0% (95% CI: 4.5, 7.5) among men and 4.0% (95% CI: 3.1, 4.8) among women, and the prevalence of undiagnosed diabetes was 2.1% (95% CI: 1.2, 3.0) among men and 1.5% (95% CI: 1.0, 2.0) among women.
Scary for me is the percentage of undiagnosed diabetes. This represents tens of thousands of New Zealanders!
Tables in the paper show how the prevalence increases with age and body mass index and that there are marked differences according to ethnicity. One third of Pacific people over the age of 45 had diabetes, yet about 40% of this was undiagnosed diabetes!
By the way – 95% CI with two numbers following means a that the 95% confidence interval for the prevalence is between the two numbers. What this means is that there is a 95% chance that confidence interval contains the true prevalence (which can only be known if everyone is measured). Eg There is a 95% chance that the 6% to 8% confidence interval contains the true prevalence of diabetes (note – 7% should be thought of as an estimate).
Tagged: Acute Kidney Injury, AKI, Chronic Kidney Disease, Diabetes, End stage renal failure, Kidney Attack 
Today’s number brought to you by Funeral Directors of New Zealand.
Kidney Attack (aka Acute Kidney Injury) is responsible for at least 1300 deaths a year in New Zealand. It used to be said that people died with Acute Kidney Injury rather than of Acute Kidney Injury. The paradigm has shifted in the last few years. Now it is recognised that an acute attack on the kidneys is a killer all by itself. Of course, the attack is still most often precipitated by another event – heart attack, serious infection, cardiac surgery etc etc etc.
A comprehensive study of nearly 20,000 hospital admissions showed that there was a 4.1 times increase in risk of death in hospital for those with Kidney Attack compared to those without. The Ministry of Health in New Zealand do not report hospital mortality data, but a very helpful MOH information analyst, Chris Lewis (thanks Chris), dug out some numbers for me. There were 7582 patients out of 548,965 discharges from public hospitals in 2011/12 who were “Discharged Dead”, Died in the emergency department, or Discharged for organ donation. This does not necessarily capture all deaths (eg Private Hospitals are not included). However, it gives me enough to go on using the proportion who died overall, the increased odds of death with Kidney Attack (4.1), the estimated number of Kidney Attack patients (30,000), and a little bit of math. The result is at least 1300 Kidney Attack deaths.
Tagged: Acute Kidney Injury, AKI, death, Kidney Attack, Mortality, World Kidney Day 
Today’s number brought to you by <You could have your name here, contact the blog writer to arrange sponsorship>
Research in other parts of the world has Kidney Attack, or Acute Kidney Injury, at ~5% of all hospital admissions. Estimates range from 2% to >9%. 5% is the generally accepted incidence. New Zealand has more than 1.1 million hospital admissions a year, with 410,000 of them day cases. 5% of the 690,000 longer stays is 34,500. 30,000 is, therefore, a conservative estimate. The NZ health stats don’t report these numbers because they are not collected. They are not collected because nearly always the cause for hospital admission is something else – heart attack, infection etc. These “something elses” all can cause Kidney Attack. Kidney Attack raises the chances of dying in hospital 4 fold.
I’d like to find the NZ incidence of Kidney Attack instead of relying on estimates based on overseas numbers. In particular, I’d like to see if there are any differences related to ethnicity. I’m searching for funding to do this.
Tagged: Acute Kidney Injury, AKI, Kidney, Kidney Attack, World Kidney Day 
How many deaths does it take? We hear that question asked time and again following a tragic event. We also hear it with calls for changes to our public health priorities. Well, I am now asking it with respect to Acute Kidney Injury.
Comparative New Zealand statistics
I would like to do them but have had problems getting funding. I especially want to look to see if there are any ethnic biases in the numbers.
If we take the US numbers and apply them to our population of 4.4 Million then there would be:
My gut reaction based on the use of dialysis in the Christchurch hospital intensive care unit is that 2350 is probably too high, maybe two to four times too high. This may reflect differences in dialysis protocols and admittance to ICU. It is less likely to reflect a lower incidence of AKI. My best guestimates are:
These numbers are greater than the road toll – another acute event.
They are comparable with Breast Cancer**.
I would like them not to be guestimates.
Maybe the funding will come next year.
The good news
My research and others over the past few years has:
Here endeth the 2012 report.
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1. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu C-Y. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol 2012; Online ahead of print.
* the data was expressed in “million-person-years” but as the data was for one year then it is OK to express it as per million people.
**The difference between AKI and many other diseases is that while AKI causes death it is almost always secondary to another event – heart attack, severe infection, cardiac surgery etc, so it is rarely recorded as THE cause of death.
Tagged: Acute Kidney Injury, AKI, Kidney, Mortality, Nephrolog 
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