Abstract: FR-PO075
Adherence to Best-Practice Guidelines in Severe AKI: A Multicenter Study
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Arora, Tanima, Yale School of Medicine, New Haven, Connecticut, United States
- Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
- Yamamoto, Yu, Yale University, New Haven, Connecticut, United States
- Biswas, Aditya, Yale University, New Haven, Connecticut, United States
- Carey, Kyle, University of Chicago, Chicago, Illinois, United States
- Churpek, Matthew M., University of Chicago, Chicago, Illinois, United States
- Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States
- Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
- Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
Background
In the absence of a specific therapy for acute kidney injury(AKI), consensus guidelines recommend certain supportive measures to improve patient outcomes. We quantified adherence to those measures in patients with severe AKI.
Methods
We reviewed the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for recommended diagnostic and therapeutic interventions after AKI. We quantified rates of adherence to 22 best practice measures at 3 hospitals within 2 health systems for patients with severe AKI (KDIGO stage 2 or higher).
Results
We identified 13,039 patients with severe AKI. The cohort was 52% women, 34% black and had a mean age of 63 years. Baseline creatinine ranged between 0.9-1.0mg/dl. Of this cohort, 42% were surgical patients and 62% were in the ICU. Among the 22 best practice measures, we found a low rate of discontinuation of nephrotoxic agents. Of patients on ACEi/ARBS 24 hours before AKI, 51% continued to use this drug upto 24hours after AKI. Similarly, 38% of patients were continued on Aminoglycosides and 42% on NSAIDs. We also observed inadequate maintenance of some hemodynamic metrics (61% of patients still had a mean arterial pressure <65mmHg upto 24hours post AKI) in patients with severe AKI (Figure).
Conclusion
We noted a low rate of adherence to certain best practice measures, particularly a failure to discontinue nephrotoxic agents in patients with severe AKI. Future research could attempt to improve adherence to best practice guidelines using electronic health record-based alerts.
Funding
- NIDDK Support