Abstract: SA-PO012
Prevalence and Variation of Best Practices in AKI: A Multi-Center Study
Session Information
- AKI Clinical: Epidemiology and Outcomes
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
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
| YNH | SRH | BH | Total | P-value | |
| N | 16,108 | 6,544 | 3,681 | 26,333 | <0.001 |
| Subsequent Creatinine, % | 68.9 | 56.3 | 57.0 | 64.1 | <0.001 |
| Urinalysis, % | 17.5 | 13.8 | 14.2 | 16.1 | <0.001 |
| Urine Output Monitoring, % | 78.8 | 79.7 | 56.4 | 75.9 | <0.001 |
| Nephrotoxin Avoidance, % | 92.4 | 92.3 | 94.1 | 92.5 | <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