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.

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