Abstract: SA-PO012

Prevalence and Variation of Best Practices in AKI: A Multi-Center Study

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
  • Biswas, Aditya, Yale University, New Haven, Connecticut, United States
  • Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
  • Mansour, Sherry, None, New Haven, Connecticut, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States
Background

AKI is common in hospitalized settings and is associated with increased morbidity, mortality, and length of stay. While there is no specific therapy for AKI, guidelines recommend certain best practice measures that could potentially form the basis of a standardized set of responses to AKI and the development of an AKI "report card". Adherence to such metrics in real-world settings is unknown.

Methods

Using guidelines published by the Kidney Disease: Improving Global Outcomes and National Institute for Health and Care Excellence, we identified four potential universal best practice metrics for hospitalized patients post-AKI including: subsequent creatinine measurement, urinalysis, urine output monitoring and avoidance of certain nephrotoxins (including aminoglycosides, non-steroidal anti-inflammatory drugs, and contrast media). We examined patients with AKI at three Connecticut hospitals to determine the rates of performance of these best practices within 24 hours of AKI onset. Patients discharged within 24 hours of AKI onset were excluded.

Results

Over three years, we identified 26,333 individuals (49.8% male, 18% black) with AKI based upon KDIGO-Creatinine criteria. The Table documents the rates of best practices across the three study hospitals and demonstrates significant variation. A multivariable model demonstrated that surgical patients, male patients, those with private insurance, and those with electrolyte abnormalities at AKI onset had more best practices performed. Of those without a creatinine measurement within 24 hours of AKI, 13.8% had progression to a higher stage of AKI, 1.5% went on to inpatient dialysis, and 6.2% died during the hospitalization.

Conclusion

Adherence to AKI best practice varies by hospital, ward, and patient factors. Standardization of best practice guidelines may help to reduce variation and improve outcomes.

Table 1 - Performance of Best Practices
 YNHSRHBHTotalP-value
N16,1086,5443,68126,333<0.001
Subsequent Creatinine, %68.956.357.064.1<0.001
Urinalysis, %17.513.814.216.1<0.001
Urine Output Monitoring, %78.879.756.475.9<0.001
Nephrotoxin Avoidance, %92.492.394.192.5<0.001

Table: Performance of best practice metrics at 3 study hospitals. YNH = Yale New Haven Hospital, SRH = St. Raphael Hospital, BH = Bridgeport Hospital

Funding

  • NIDDK Support