RENAL CONSULT AUDIT AT A TERTIARY REFERRAL HOSPITAL

CM OGILVY1, H GOCK1, L NGUYEN2, F IERINO1, SL FORD1

1St Vincent’s Hospital, Melbourne, Victoria; 2School of Medicine, The University of Melbourne, Victoria

Aim: To characterise inpatients referred to nephrology within a tertiary hospital, analysing patterns of acute kidney injury (AKI), patient outcomes, and identifying areas for quality improvement.

Background: AKI is common, has high morbidity and mortality and predicts adverse outcomes.

Methods: A retrospective review of patients referred to St Vincent’s Hospital nephrology unit over 3-months from July to October 2016. Utilising medical records and results databases, patient demographics, referral characteristics and renal outcomes were assessed.

Results: 55 patients were analysed, 58% were male and two-thirds over 60yo. 50% were admitted under medical units and 75% had >4 comorbidities. 52% were referred within 48 hours of admission. Baseline renal function included CKD Stage 1 in 27%, Stage 2 in 18%, Stage 3 in 31%, Stage 4 in 11%, Stage 5 in 4% and 9% unknown.

Classification of AKI was pre-renal in 24%, renal in 65% and post renal in 11% of patients. Patients with post-renal AKI presented with the highest peak creatinine (post-renal 896+/-245μmol/L vs renal 354+/-33μmol/L, p<0.0001 vs pre-renal 248+/-20μmol/L, p=0.001) and the worst renal function at discharge (post-renal 449+/-103μmol/L vs renal 182+/-21μmol/L, p<0.005 vs pre-renal 173+/-22μmol/L, p<0.001). Upon discharge, more than half had serum creatinine up to 50% higher than baseline. Patients with renal AKI had the highest rate of dialysis (renal 42% vs pre-renal 0% vs post renal 17%) while pre-renal patients had the lowest inpatient mortality (renal 17% vs pre-renal 0% vs post renal 17%).

Conclusions: AKI in referred hospitalised patients is associated with a high level of morbidity and mortality. Patients with post-renal causes of AKI presenting with severe AKI are at significantly higher risk of worsened renal function at discharge.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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