Abstract: SA-PO022

Weighting the AKI Risk of Individual Nephrotoxins

Session Information

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
INDOMETHACIN13
CYTARABINE12
ACYCLOVIR
AMIKACIN
TACROLIMUS
CEFTAZIDIME
11
GENTAMICIN10
CARBOPLATIN
CAPTOPRIL
METHOTREXATE
IOVERSOL
9
LISINOPRIL8
NEOMYCIN7
LOSARTAN6
ASPIRIN4
NAPROXEN2
IBUPROFEN
BLEOMYCIN
KETOROLAC
CISPLATIN
1
PENTAMIDINE
PAMIDRONATE
MESALAMINE
MELOXICAM
ENALAPRILAT
0