Abstract: SA-PO108
Improved Outcomes with Early Nephrology Consultation After Biomarker Measurement
Session Information
- AKI: Biomarkers, Imaging, Interventions
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 days | 9 (45%) | 10 (100%) | 0.004 |
| Net I/O (mL) in 7 days | -1787.4 (6716) | +4973.7 (15540) | 0.47 |
| Diuretic Exposure | 19 (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 Dialysis | 2 (10%) | 7 (70%) | 0.002 |
| Inpatient Mortality | 1 (5%) | 4 (40%) | 0.031 |