Abstract: TH-OR04
Nephrotoxin Exposure and AKI: A Magnitude Assessment Using NINJA Methodology in the Adult Population
Session Information
- AKI: Pathways, Predictors, and Prevention
November 04, 2021 | Location: Simulive, Virtual Only
Abstract Time: 04:30 PM - 06:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Griffin, Benjamin R., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Hounkponou, Hermann, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Misurac, Jason, The University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, United States
Background
The Nephrotoxic Injury Negated by Just-in Time Action (NINJA) program was designed to identify pediatric patients with high exposure to nephrotoxic medications (NTMx) and to reduce rates of acute kidney injury (AKI). In children, this program resulted in a 23.8% reduction in NTMx-AKI. However, equivalent rates of NTMx-AKI in adults are largely unknown. We report rates of NTMX-AKI in adults through application of the NINJA screening tool in an adult population.
Methods
Adult non-ICU patients admitted to the University of Iowa hospital between January 1, 2019 and December 31, 2019 were included in this retrospective analysis. We excluded emergency department encounters, pregnant patients admitted for delivery, and patients with end-stage kidney disease. High NTMx exposure was defined per NINJA protocol as receiving ≥ 3 NTMx on one day or intravenous aminoglycoside or vancomycin for ≥ 3 days (list of NTMx previously published). Patient charts were screened daily by an automated NINJA algorithm for high NTMx exposure and for AKI, defined as a creatinine increase of ≥0.3 mg/dL or to 1.5x baseline. Patients could have more than one NTMx exposure or AKI episode if separated by 48 hours from resolution of a prior event. NTMX-AKI was defined as an AKI event occurring during or within 48 hours of a high NTMx exposure.
Results
There were 4,596/33,835 (13.6%) patients with at least one day of high-NTMx exposure, and 17,254/144,997 (11.9%) of hospital days met high NTMx exposure criteria. AKI of any etiology was seen in 3,398 (10%) of patients, of which 1,467 (43.2%) also had at least one day of high-NTMx exposure. In 943 of these 1467 cases (64.3%), NTMx exposure preceded AKI development, by a median of 5 days. There were 6,038 total exposures and 1,131 NTMx-AKI events, for an AKI rate of 18.7% following high NTMx exposure. Serum creatinine was checked on 89% of days on or within 48 hours of high NTMx exposure.
Conclusion
Rates of NTMx exposure in adults are substantial, accounting for 12% of all hospitalized patient-days. Rates of AKI following high NTMx exposure were 18.7%, suggesting that high NTMx exposure is a contributing factor in a large number of AKI cases. These findings support implementation of interventions like the NINJA program in adults in order to reduce rates of NTMx-AKI.