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Kidney Week

Abstract: PO0222

Detection and Diagnosis of AKI in the Emergency Department

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Kristjansdottir, Margret, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Ragnarsdóttir, Telma Huld, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Gislason, Gisli, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  • Sanchez-Brunete, Vicente, Department of Emergency Medicine, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Palsson, Runolfur, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
Background

Acute kidney injury (AKI) represents an abrupt decline in kidney function occurring over hours or days and is associated with inferior clinical outcomes. In recent years, new definitions of AKI based on changes in serum creatinine (SCr) have gained acceptance, but awareness by primary care and emergency physicians may still be limited. The aim of this study was to use diagnosis codes to examine the detection of AKI among patients who presented to the emergency department (ED).

Methods

This was a prospective case-control study in which SCr of all individuals admitted to the ED of Landspitali–The National University Hospital in Reykjavik were examined by the research team for the presence of AKI. We present data from January 1 until March 3, 2020, from May 19 until September 21, 2020 and from February 1 until May 1, 2021. The study was paused between these periods due to COVID-19 outbreaks. All patients who met the KDIGO criteria for AKI were invited to participate. Clinical information and ICD-10 diagnoses were obtained from participants and from electronic medical records. ICD-10 codes N17 (acute kidney failure) and N19 (unspecified kidney failure) were used as indicative of a confirmed AKI diagnosis.

Results

A total of 527 cases of AKI were identified, 445 (84%) of whom participated in the study. The mean (±SD) age of AKI cases was 67.2±16.8; 47% were female. Of the AKI cases, 104 (23.4%) had a documented diagnosis of AKI in the ED. No difference was found between women and men (20.9% and 23.9%, respectively; p=0.85) and no difference was observed between different age groups (18-49 years 23.9%, 50-69 years 21.7% and >70 years 21.7%). Of 39 (8.7%) participants with pre-existing diagnosis of chronic kidney disease (CKD), 38.5% had a documented AKI diagnosis compared with 21.9% of those without history of CKD (p=0.003). Participants with stage 3 AKI had a documented diagnosis in 48.0% of cases, 25.2% of those with stage 2 AKI and 15.1% of cases with stage 1 AKI.

Conclusion

AKI appears to be seriously underdiagnosed in the ED. While multiple factors may affect the use of diagnosis codes, lack of awareness of recent AKI guidelines among emergency physicians may play an important role. Measures must be taken to improve the diagnosis and documentation of AKI in the ED.

Funding

  • Government Support – Non-U.S.