Kidney Week

Abstract: FR-OR013

Community AKI Reporting Improves Longer-Term Patient Outcomes

Session Information

• AKI: Can We Improve Outcomes?
  October 26, 2018 | Location: 6A, San Diego Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Jain, Seema, South West Thames Renal Unit, Carshalton, United Kingdom

Seema Jain, MBBS



My name is Jane Manning and I am currently a “Core Medical Trainee” (junior doctor) working in Eastbourne DGH, south coast of England. I am originally from Northern Ireland and did my undergraduate training at Edinburgh Medical School (Scotland). I have recently finished a Masters Degree in Medical Ethics and Law. I participated in this project whilst working in the Acute Medical Unit at Epsom And St. Helier University Hospitals in conjunction with Dr Seema Jain and Dr Bhrigu Raj Sood (Consultant Nephrologists).

• Manning, Jane E., Epsom And St. Helier University Hospitals, Epsom, United Kingdom

Jane E. Manning,

• Sood, Bhrigu Raj, South West Thames Renal Unit, Carshalton, United Kingdom

Bhrigu Raj Sood,

Background

More than half a million patients develop AKI in England per year. Two-thirds of these occur in the community. AKI episodes have long-term implications with regard to morbidity and mortality. To improve detection of AKI in the community, automated detection systems have been developed to generate an ‘AKI Alert’ alongside blood test reports. In this study, we assess the outcomes of patients 3 years after the episode of AKI was detected.

Methods

AKI alerts were generated using the UK national AKI algorithm. Only blood tests done in the community were considered. 3-year outcomes were analysed for patients with AKI alerts in December 2014. Worsening renal function was defined as an increase in CKD stage by 1 or more.

Results

79 AKI alerts were issued over this time period. Of these, 9 were excluded from analysis as 3 were repeat alerts and data was missing for 6.
The median age of the patients in which AKI was detected was 80 (Min 22, Max 94). 45 patients had pre-existing CKD with 43% of the total cohort having an eGFR 30-60 and 21% having an eGFR of less than 30.
19 of the 70 alerts were incorrect with 95% overstating the stage of AKI as defined by KDIGO criteria.
In cases when AKI was reported correctly, 70% of patients died or had worse renal function 3 years after the episode of AKI.
In 71% of cases where an episode of AKI was detected by the algorithm, the alert led to a repeat blood test within 4 weeks. However, in the patients that did not have a repeat blood test in this time frame, there was a higher proportion of falsely reported AKI (45% versus 16%). This might be expected as the clinician may be less likely to repeat the test if deemed not to be a true episode of AKI.
Patients in which the alert resulted in a repeat blood test in 4 weeks had a lower incidence of worsening renal function (40% vs 55%) and a composite outcome of death or worsening renal function (69% vs 73%) at 3 years.

Conclusion

A high proportion of patients who have an incidence of ‘community’ AKI go on to develop worsening CKD or death within 3 years.
In cases when the AKI alert led to further investigation, there was a lower incidence of death and progressive renal dysfunction compared to cases where no action was taken. This suggests that a community blood test-based AKI alert system leads to longer lasting improved patient outcomes.