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Kidney Week

Abstract: FR-PO012

Evaluation of Finger-Stick Point of Care Creatinine Assay for Early Diagnosis of AKI in the Community

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Storrar, Joshua, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Ritchie, James, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Darby, Denise, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Alshawy, Khalid, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Sinha, Smeeta, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Poulikakos, Dimitrios J., Salford Royal NHS Foundation Trust, Salford, United Kingdom

Group or Team Name

  • Renal Medicine Department
Background

Acute kidney injury (AKI) is a major health problem which occurs in the context of infection in more than 50% of cases. Recent guidance for sepsis mandates the delivery of a sepsis bundle within one hour of presentation in patients with suspected infection and AKI. However, the majority of these cases arise in the community. Primary care physicians need to make a decision for hospital referral at the first assessment. The aim of this study was to evaluate finger-stick capillary point of care (POC) creatinine (Cr) testing for real time diagnosis of AKI and evaluate its role in the clinical decision making process during the assessment of sepsis in nursing home residents.

Methods

The precision of the POC Cr assay was measured as coefficient of variation (CV) ie the ratio of the standard deviation to the mean over 5 repeated measurements. Correlation, reliability and agreement were estimated by using Pearson’s correlation, Intraclass Correlation Coefficient calculation and the Bland-Altman method respectively. POC Cr from finger-stick capillary samples, along with concurrent serum Cr samples measured by Siemens Advia 2400 Jaffe in our laboratory, were collected from nursing home residents and A&E patients.

Results

Mean CV from 9 samples with 5 repeated measurements was 0.044±0.018 (min=0.018, max=0.081). There were 70 paired samples from 66 patients aged 78±17. POC Cr was 116±64umol/L and Serum Cr 84±41umol/L. Pearson correlation was 0.804 (p=0.000), Figure 1A. Average Intraclass Correlation Coefficient was 0.843 (confidence interval 0.748-0.903, p=0.000). Bland-Altman plot is presented in Figure 1B. Mean difference between POC Cr and Serum Cr was 32±39, 4 values were outside the limits of agreement defined as mean difference ±1.96 SD (95% confidence interval) and 3 of 4 were above 200.

Conclusion

Finger-stick POC Cr has good agreement with laboratory method and may be used to assist clinical decision making. It can reliably detect severe AKI stages 2 and 3. POC Cr tends to overestimate serum Cr and has decreased agreement in Cr values above 200 umol/L.