Abstract: SA-PO022
Weighting the AKI Risk of Individual Nephrotoxins
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
- Yonekawa, Karyn, Seattle Children''s Hospital/UW, Seattle, Washington, United States
- Zhou, Chuan, Seattle Children''s Research Institute, Seattle, Washington, United States
Background
Seattle Children’s Hospital’s AKI surveillance system monitors the use of medications suspected to be nephrotoxic and for nephrotoxin-related AKI. An alert to the prescriber is triggered when >3 nephrotoxins are ordered. Our current system’s sensitivity is 32% in detecting nephrotoxin-related AKI. To improve surveillance, we aimed to determine an individual risk weight for each nephrotoxin and develop a new alert system based on a scoring rule rather than on the number of nephrotoxins prescribed.
Methods
Nephrotoxin orders and AKI alert information (n=23,744) for 2 years (2013-2015) from a large tertiary-care children’s hospital were analyzed. A risk weight was constructed for each nephrotoxin using the estimated probability of AKI when the nephrotoxin was present (either alone or in combination with other nephrotoxins). Nephrotoxic medication orders were scored by totaling the constructed risk weights of the individual nephrotoxins. We conducted ROC analysis on the final scores to determine alert thresholds and assess sensitivity and specificity.
Results
Using a total score threshold of 16 to trigger an alert, our model system’s sensitivity and specificity was 70% and 80%, respectively. A total score threshold of 14 delivered a sensitivity of 83% and a specificity of 75%.
Conclusion
A surveillance system using individual risk weights for nephrotoxins and a scoring rule delivers improved nephrotoxin-related AKI detection. Additional work is needed to expand our analysis beyond the original list of suspected nephrotoxins to include other medications frequently prescribed in patients who are at risk for AKI.
Individual Weigths of Nephrotoxins
| CIDOFOVIR FOSCARNET CYCLOSPORINE GANCICLOVIR TOBRAMYCIN | >16 |
| VALACYCLOVIR PIPERACILLIN/TAZOBACTAM VANCOMYCIN SIROLIMUS VALGANCICLOVIR ENALAPRIL | 15 |
| INDOMETHACIN | 13 |
| CYTARABINE | 12 |
| ACYCLOVIR AMIKACIN TACROLIMUS CEFTAZIDIME | 11 |
| GENTAMICIN | 10 |
| CARBOPLATIN CAPTOPRIL METHOTREXATE IOVERSOL | 9 |
| LISINOPRIL | 8 |
| NEOMYCIN | 7 |
| LOSARTAN | 6 |
| ASPIRIN | 4 |
| NAPROXEN | 2 |
| IBUPROFEN BLEOMYCIN KETOROLAC CISPLATIN | 1 |
| PENTAMIDINE PAMIDRONATE MESALAMINE MELOXICAM ENALAPRILAT | 0 |