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Under-detection of Acute Kidney Injury in Hospitalised Patients - A Retrospective, multi-site, longitudinal study.
Intern Med J. 2019 Feb 28;:
Authors: Campbell CA, Li L, Kotwal S, Georgiou A, Horvath AR, Westbrook J, Endre Z
Abstract
BACKGROUND: Acute kidney injury (AKI) is a rapid deterioration of renal function, often caused by a variety of co-existing morbidities complicating its recognition and treatment, leading to short- and long-term adverse clinical outcomes. There are limited data on the incidence of AKI in Australia using the Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based consensus definition.
AIM: To determine the incidence and estimate the extent of under-reporting of AKI in four hospitals in the South-Eastern Sydney/Illawarra regions of New South Wales, Australia.
METHOD: A laboratory algorithm based on the KDIGO creatinine-based definition for AKI was applied retrospectively to laboratory data for adult patients admitted to the study hospitals between 2009 and 2013 to identify those with AKI. The results were compared to the incidence of AKI based on diagnostic codes for AKI reported for the same period.
RESULTS: AKI was detected in 12.4% of all hospitalisations (46,101/370,969) and 16.4% of patients (31,448/192,133) across the 5 year study period using the laboratory algorithm. Of these, 72.1% were AKI Stage 1 (33,246/46,101). AKI was coded in only 15.9% of hospitalisations with AKI Stage 1 (5,294/33,246), 38.5% of hospitalisations with Stage 2 (2,381/6,185), and 46.8% with Stage 3 (3,120/6,670). Yearly incidence of laboratory-identified AKI trended downward between 2009 and 2013, while annual incidence determined by coding trended upward.
CONCLUSION: Although coding trends suggested a continuous increase in clinician awareness of AKI across the study period, AKI in hospitalised patients remained significantly under-reported. This article is protected by copyright. All rights reserved.
PMID: 30816607 [PubMed - as supplied by publisher]