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Kidney Week

Abstract: SA-PO108

Improved Outcomes with Early Nephrology Consultation After Biomarker Measurement

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • La, Ashley, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Swamy, Varsha, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Gunning, Samantha, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Koyner, Jay L., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
Background

Novel urinary biomarkers, including Tissue Inhibitor Metallo-protease-2 and Insulin-like Growth Factor Binding Protein 7 ([TIMP-2]*[IGFBP7], T2*I7), have been developed to predict which patients are at risk for stage 2/3 AKI. While T2*I7 is approved as a risk stratification tool, data on its “real-world” use in conjunction with Nephrology consult and impact on AKI care 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. T2*I7 measurements and Nephrology consults were at the discretion of the primary ICU team. ICU providers were given KDIGO AKI-guideline-based practice recommendations based on T2*I7 results.

Results

Of 116 patients, 86(74%) had elevated T2*I7 ≥0.3. Of those, 30(26%) patients received nephrology consultation, 20 of whom had consultation within 1 day of T2*I7 measurement (early consult), and 10 had consults on days 2 or later (delayed consult). Patients with early and delayed consults had similar T2*I7 values (mean(SD) 3.0(3.1) vs 3.0(2.9), p=0.89), SCr at T2*I7 measurement (2.0(0.7) vs 2.0(0.5), p=0.75), and incidence of stage 1 AKI at time of T2*I7 measurement (15(75%) vs 9(90%), p=0.63). Despite more exposure to nephrotoxins, patients with early consults had significantly lower incidence of severe AKI, less dialysis, and improved mortality (p<0.05 for all) (Table). With renal consultation, T2*I7 was a poor predictor of severe AKI in 7 days (AUC 0.56(0.32-0.79), p=0.61).

Conclusion

Despite similar baseline characteristics and biomarker values, early nephrology consults were associated with improved outcomes and diminished the ability of T2*I7 to predict severe AKI. Future studies should continue to investigate if early kidney care, prompted by T2*I7, is beneficial in high-risk AKI patients.

Outcomes of Early vs Delayed Nephrology Consult
 Early Consult (n=20)Delayed Consult (n=10)p-value
Peak Change in SCr in 7 days (mg/dL)2.7 (1.4)4.7 (1.6)0.003
Incidence of Stage 2 or 3 AKI in 7 days9 (45%)10 (100%)0.004
Net I/O (mL) in 7 days-1787.4 (6716)+4973.7 (15540)0.47
Diuretic Exposure19 (95%)8 (80%)0.25
Exposure to Nephrotoxins
(exposure x days exposed)
1.7 (2.4)0.6 (1.0)0.27
Length of Stay in ICU (days)15.5 (11)31.3 (23)0.062
Total Length of Stay (days)27.6 (16.5)43.3 (21.0)0.024
Inpatient Receipt of Dialysis2 (10%)7 (70%)0.002
Inpatient Mortality1 (5%)4 (40%)0.031