S TEO1, S KOTWAL1,2, C CAMPBELL3, Z LIU4, S HERATH1, A HORVATH3, Z ENDRE1
1Department of Nephrology, Prince Of Wales Hospital, Sydney, Australia, 2The George Institute for Global Health, UNSW, Sydney, Australia, 3NSW Health Pathology, Department of Clinical Chemistry and Endocrinology, Prince of Wales Hospital, Sydney, Australia, 4Stats Central, University of New South Wales, Sydney, Australia
Aim: To evaluate short-term outcome and clinical management of AKI detected by electronic alerts (e-alerts).
Background: AKI, common in hospitalized patients, is associated with high mortality. Evidence on assessment of AKI management is limited.
Methods: We prospectively identified 200 consecutive AKI episodes (KDIGO) with a validated creatinine-based algorithm. Patients with CKD Stage 5 (maintenance dialysis, renal transplant and eGFR < 15mL/min) were excluded. Treating clinicians were blinded to the e-alerts. Renal recovery was defined as return of eGFR to within 90% of baseline at discharge. We measured the incidence of AKI, and used electronic medical records to determine mortality, referral to nephrology, the proportion of patients with AKI recognized by the treating team, and to assess compliance with KDIGO management guidelines.
Results: The median age was 73 years (IQR 63-83). The majority were male, 57% (113), and median baseline eGFR was 56mL/min (IQR 38-72). In-hospital mortality was 12% (24). Eighty four percent (168) had underlying CKD. Volume depletion and reduced cardiac output were the most common causes, in 47% (94). Only 17% (34) were referred to nephrology. Referred patients were younger and of higher AKI stage. AKI was not recognized in 32% (63), with 41% continuing nephrotoxins and only 32% stopping RAS blockade. Despite recognition of AKI, 6 out of 11 patients had supratherapeutic vancomycin levels while 26% (35) patients did not receive intravenous volume replacement. On discharge, the renal recovery rate was the same (35% in unrecognized versus 36% in recognized patients).
Conclusions: AKI was not recognized in one third with consequent deficiencies in appropriate management. Implementation of e-alerts may allow early identification of AKI and improve clinical management.
Dr Su Hooi Teo graduated with MD from the University of Calgary, Canada in 2005. She obtained her Membership from the Royal College of Physicians (MRCP) (United Kingdom) in 2011 and has subsequently completed her Advanced Specialty Training in Nephrology in Renal Medicine (Singapore) in 2014. She is currently undertaking a fellowship in Acute Kidney Injury (AKI) in Prince of Wales Hospital, Sydney. Her area of interests include General Nephrology, Critical Care Nephrology, Glomerular diseases and Hemodialysis.