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Kidney Week

Abstract: TH-PO002

Real-Time, Model-Driven Diagnostic and Therapeutic Evaluation of Patients at Risk of AKI: A Pilot and Feasibility Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
  • Ugwuowo, Ugochukwu Caleb, Yale University , New Haven, Connecticut, United States
  • Martin, Melissa, Yale School of Medicine, New Haven, Connecticut, United States
  • Biswas, Aditya, Yale University , New Haven, Connecticut, United States
  • Yamamoto, Yu, Yale University , New Haven, Connecticut, United States
Background

Acute kidney injury is typically defined by a rise in serum creatinine, but this is a late marker of the syndrome. Real-time, updated modeling of AKI risk using electronic health record (EHR) parameters may allow for targeting of diagnostic and therapeutic interventions earlier in the course of AKI.

Methods

We deployed a time-updated AKI prognostic model into the EHR of a large, tertiary care hospital. The model alerted study team members when any hospitalized adult had a greater than 30% risk of developing AKI within the next 48 hours: the “pre-AKI Alert”. Study personnel took urine and blood samples, examined the medical record, and followed patients for the development of creatinine-defined AKI. Our primary goal was to determine the feasibility of providing tailored pre-AKI recommendations in this clinical setting.

Results

Of 98 patients who met eligibility criteria, 68 were unable or refused to consent to study participation. Of the 30 who were enrolled, 5 developed AKI within 24 hours, 1 additional patient within 48 hours, and 1 later during the subsequent hospital admission. Lower-than-expected AKI rates were seen due to difficulty obtaining consent from the highest-risk patients. At the time of pre-AKI alert, 3 patients were receiving a potentially nephrotoxic agent, 24 had at least one electrolyte abnormality that could be addressed, and 3 had mean arterial pressure < 65mmHg (Table). Oxygen saturation was significantly lower in those who went on to develop AKI compared to those who did not with median (IQR) SPO2 94 (92 - 94) compated to 97 (95-98), p=0.03.

Conclusion

A real-time updated model successfully identified a group of patients at high risk for AKI, many of whom had nephrotoxin, electrolyte, blood pressure, or oxygenation abnormalities that could be proactively addressed. Model-based pre-AKI interventions are feasible and their efficacy should be explored in a larger study.

Characteristics at Pre-AKI Alert
 AKI within 48h (N=5)No AKI Within 48h (N=25)Total (N=30)
Potassium > 5.4 meq/L123
Bicarbonate < 22 meq/L31821
MAP < 65 mmHg123
Receiving Nephrotoxin033
Scheduled for Contrast Study022

Funding

  • NIDDK Support