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Kidney Week

Abstract: FR-PO031

Adherence to AKI Best Practice Guidelines in Hospitalized Children

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Sandokji, Ibrahim, Yale School of Medicine, New Haven, Connecticut, United States
  • Yamamoto, Yu, Yale School of Medicine, New Haven, Connecticut, United States
  • Biswas, Aditya, Yale School of Medicine, New Haven, Connecticut, United States
  • Greenberg, Jason Henry, Yale School of Medicine, New Haven, Connecticut, United States
  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States

Group or Team Name

  • Program of Applied Translational Research
Background

The Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines recommends a non-invasive diagnostic workup and cessation of nephrotoxins in all stages of AKI. We evaluated the provider adherence to these consensus guidelines in hospitalized children

Methods

We reviewed the medical records of children <18 years old, who had at least two creatinine values measured during a hospital admission in a large, tertiary care hospital. We defined AKI based on serum creatinine per the KDIGO guidelines, with a minimum absolute creatinine value of 0.5 mg/dL. We calculated the baseline daily rates of performing non-invasive diagnostic tests such as urinalysis in children with AKI compared to all patients in the cohort. To evaluate adherence to general preventive measures, we calculated the percentage of patients who continued to receive nephrotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) after the development of AKI

Results

Among the 8634 encounters studied, AKI occurred in 779 (9%) encounters. Median age was 4.5 years [IQR, 0-13.2], 4559 (52.8%) were male, and 48% were admitted to the ICU (PICU or NICU). Development of AKI increased the rate of receiving a repeat creatinine measurement from a baseline 54% to 81% per day in children with AKI, a urinalysis from 6% to 19%, and a renal ultrasound from 1% to 6%. Children with AKI were 5 times more likely to have a nephrology consultation as compared to those without AKI. After developing AKI, 30/67 (44.8%) children receiving NSAIDs and 10/16 (62.5%) children receiving angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers continued receiving them (Figure)

Conclusion

We identified gaps in provider adherence to AKI management guidelines in hospitalized children. We recommend establishing electronic health record-integrated best practice bundles to improve care for children with AKI

Percentage of patients continued on nephrotoxic medications after developing AKI

Funding

  • NIDDK Support