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Kidney Week

Abstract: TH-PO023

Impact of Practice Guidelines in Critically Ill Patients at Risk for AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • La, Ashley, The University of Chicago Medicine, Chicago, Illinois, United States
  • Gunning, Samantha, The University of Chicago Medicine, Chicago, Illinois, United States
  • Koyner, Jay L., The University of Chicago Medicine, Chicago, Illinois, United States
Background

Novel urinary biomarkers, including Tissue Injury Metallo-protease-2 and Insulin-like Growth Factor Binding Protein 7 ([TIMP-2]*[IGFBP7] or T2*I7), have been developed to predict which ICU patients are at risk for severe AKI (stage 2/3). While T2*I7 has been validated as a risk stratification tool, data on its “real-world” impact on patient care outside of clinical trials is lacking.

Methods

We conducted a single-center prospective quality improvement study of ICU patients at risk for AKI or with KDIGO serum creatinine (SCr) stage 1 AKI at the University of Chicago. T2*I7 measurements were made via the hospital lab at the discretion of the ICU team. ICU providers were given KDIGO AKI-guideline-based practice recommendations based on T2*I7 results. The use of these guidelines and clinical outcomes were compared amongst patients with T2*I7 of <0.3, 0.3-2, and >2.

Results

Of 105 ICU patients included in our analysis, 66(63%) had stage 1 AKI at time of biomarker measurement. A higher proportion of patients with T2*I7 >2 had stage 1 AKI compared with T2*I7 ≤2 (25(78.1%) vs 41(56.9%), p = 0.038). There was no significant difference in peak change in SCr (mean(SD)) within 7 days of biomarker measurement between T2*I7 >2 (0.48(1.09)) and T2*I7 ≤2 (0.17(0.58)) (p = 0.24). There was also no difference in proportions of patients who progressed to severe AKI in 7 days (10(31.3%) vs 14(19.2%), p = 0.5). Across the entire cohort, AUC(SE) for T2*I7 as a predictor of severe AKI in 48 hours was 0.65(0.11), p=0.06.

Conclusion

Despite having higher T2*I7 levels and more stage 1 AKI, those ICU patients with values >2 did not progress to have significantly more stage 2 or 3 AKI. When used in conjunction with guideline-based care, T2*I7 can improve the outcomes of ICU patients.

Outcomes of ICU Patients by Urinary [TIMP-2]*[IGFBP7]
 [TIMP-2]*[IGFBP7] ≤ 2
(n = 73)
[TIMP-2]*[IGFBP7] > 2
(n = 32)
p-value
Nephrology consults12 (16.4%)13 (40.6%)0.01
Pharmacy consults34 (46.6%)17 (53.1%)0.67
Net intake/output (mL) (SD)-2776 (6224)1033 (10509)0.07
Incidence of nephrotoxin exposure (SD)5.53 (4.9)4.19 (3.0)0.25
Peak change in SCr in 7 days (mg/dL) (SD)0.17 (0.58)0.48 (1.09)0.24
Inpatient mortality4 (5.5%)5 (15.6%)0.13
Inpatient dialysis4 (5.5%)5 (15.6%)0.13