Abstract: FR-PO948

Preventing Unnecessary Renal Replacement Therapy for AKI: A Quality Improvement Project

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety

Authors

  • Douvris, Adrianna, University of Ottawa, Ottawa, Ontario, Canada
  • Zeid, Khalid, University of Ottawa, Ottawa, Ontario, Canada
  • Hiremath, Swapnil, University of Ottawa, Ottawa, Ontario, Canada
  • Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Clark, Edward George, The Ottawa Hospital and Kidney Research Centre - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
Background

AKI is a frequent complication in hospital with the highest mortality observed in patients requiring renal replacement therapy (RRT). Also, RRT for AKI may be harmful for renal recovery. There are no effective pharmacological interventions to treat established AKI. Treatment focuses on limiting further renal damage, and reducing the risk of requiring RRT. Our objective is to characterize events that contribute to potentially avoidable RRT for AKI patients at the Ottawa Hospital. Ultimately, our results will serve as a guide to create a clinical pathway for AKI to limit iatrogenic harm in this population.

Methods

This is a retrospective cohort study of 100 consecutive patients who required acute RRT for AKI while hospitalized at TOH between July 1, 2015-August 31, 2016. Inclusion criteria: age 18 or over, and all dialysis modalities except peritoneal dialysis. Exclusion criteria: end stage kidney disease (ESKD), and RRT within 72 hours of admission. The main outcome is the frequency of iatrogenic events in the period after AKI but prior to RRT that may cause harm.

Results

We screened 344 charts to include 100 patients. Admission diagnoses were sepsis (26%), cardiac (31%), surgical (18%) and renal (15%). 36% of patients required ICU, CCU, or cardiac surgery ICU (CSICU) care at one point. Possible AKI etiologies cited: pre-renal (51%), ATN (68%), AIN (16%), and post-renal (6%). Contrast-induced nephropathy was suggested in 27%. Volume overload was the most common indication for initiating RRT; hyperkalemia was cited as an indication in 32%. Relative hypotension from anti-hypertensives was cited as an AKI contributor in 7%. With regards to nephrotoxins post-AKI, NSAIDs were continued in 3%, ACEi/ARB in 16%, and spironolactone in 13%. Of the 32 patients dialyzed with hyperkalemia, only 43.7% were placed on a low K+ diet, and 7% received a form of additional K+ after AKI and with a serum K+≥5.

Conclusion

Our study includes many seriously ill patients with AKI where RRT is likely unavoidable. However, we have identified potentially harmful events. These include nephrotoxic medications, iodinated contrast dye, potassium supplementation, and hypertension management. Upon completion, we plan to use our data to create solutions that will hopefully reduce the risk of iatrogenic harm for hospitalized AKI patients.