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Kidney Week

Abstract: PO0684

Can the AKI Alert Staging Tool Help Manage Patients Admitted During the COVID Pandemic?

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

Authors

  • Mohidin, Barian, Mid and South Essex University Hospitals Group, Basildon, Essex, United Kingdom
  • Chatterjee, Devnandan A., Mid and South Essex University Hospitals Group, Basildon, Essex, United Kingdom
  • Khamba, Gurminder S., Mid and South Essex University Hospitals Group, Basildon, Essex, United Kingdom
  • Winnett, Georgia, Mid and South Essex University Hospitals Group, Basildon, Essex, United Kingdom

Group or Team Name

  • Kidney Medicine, Basildon & Thurrock University Hospital
Background

Basildon & Thurrock University Hospital has the second highest rate of hospital admissions with AKI stage 3 in the United Kingdom based on Renal Registry Hospital Episode Submission Data. Acute kidney injury (AKI) is common in hospitalized patients and carries a higher risk of mortality. Given the limitations of resources both personnel and equipment, a retrospective study was done to see if the AKI alert staging tool could help predict and direct resources to those patients who would benefit most from specialist intervention.

Methods

Data was reviewed from January - May 2020. This corresponded to the peak of admissions and by the end of the period, the hospital was on course to returning to pre pandemic activity. Relevant data including admission laboratory tests and imaging was collected. The admission stay was analysed for duration, the need for transfer to an intensive care environment to receive ventilator support and/or renal replacement therapy. Discharge destination was reviewed and whether the patient was discharged home, to another facility or did not survive the admission. For comparison we looked at the same period in the preceding year as this would represent the most matched population.

Results

Over 5000 AKI alerts were generated for this period for 4390 unique admissions. This compares to 3910 AKI alerts for 1098 unique admissions for the identical period in the previous year. The vast majority were for AKI stage one alerts none of which were in COVID positive patients. A significant proportion of patients with AKI Stage 2 and 3 alerts were positive for COVID. Those that were admitted to Intensive Care with Stage 3 AKI almost always required intubation and renal replacement therapy. Mortality was higher in this group.

Conclusion

The AKI alert system helps identify patients who are unwell and can benefit from Nephrologist input at an early stage. The Alert algorithm excludes haemodialysis patients, therefore this population was excluded. During the COVID pandemic there was a clear increase in AKI admissions and alerts creating a substantial demand on renal services. Specialist intervention should be directed to AKI alert stage 2 patients where intervention can help prevent progression into AKI stage 3 and subsequent ICU admission. AKI stage 1 patients who are COVID negative can be managed without specialist input.