ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

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