Z BARAKAT1, D LANGSFORD1,2, T PIANTA1,2
1Northern Clinical School, Melbourne Medical School, Epping, Australia, 2Northern Health, Epping, Australia
Aim: To determine accuracy of acute kidney injury (AKI) diagnosis and referral to inpatient and outpatient nephrology services in a metropolitan hospital including factors influencing these practices.
Background: AKI is common and serious but variably detected. There is limited Australian data regarding variability in diagnosis, documentation, and involvement by nephrology units in acute and long-term management.
Methods: Scanned and electronic medical records, funding codes, and clinic records were manually examined in 377 adults with a multi-day admission to Northern Hospital in July 2016. Diagnosis of AKI and stage was determined by Kidney Disease Improving Global Outcome (KDIGO) 2012 sCr criteria. Clinic appointments, readmission, and death were examined to 12 months.
Results: Chart review identified 102 (27%) patients with AKI, (73% stage 1, 13% stage 2, 14% stage 3). In those patients, AKI was recorded in 49% (95%CI: 40-59%) of notes and 30% (95%CI: 22-40%) of discharge summaries. AKI was diagnosed in 12 patients not meeting KDIGO sCr criteria and no sCr was available in 19 patients. Factors associated with missed diagnosis were AKI stage 1, no CKD, and English as a second language.Nephrology referral occurred in 11% (95%CI: 6-18%) of all AKI cases. Prior outpatient nephrology care was identified in 17 patients with AKI with 7 further referrals generated after AKI diagnosis.After 12 months patients with AKI had greater rates of death (29% vs 11%; 95%CI for difference 8-28%) but lower incidence of readmission (51 vs 39%; 95%CI: 1-24% difference).
Conclusions: Non-diagnosis and non-recording of AKI was common. Policies to improve AKI outcomes should address improving diagnosis and recognise that nephrologists are currently involved in a minority of cases as inpatients and outpatients.
Zena is a final year medical (Doctor of Medicine, MD) student at Melbourne University who undertook an MD Research Project (MDRP) examining AKI diagnosis, referral and outcome. She wishes to pursue a career in nephrology.