Kidney Week

Abstract: SA-PO024

Targets for Improvement of Care for Hospitalized Patients with AKI

Session Information

• AKI: Clinical, Outcomes, and Trials - Management
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• de Martines, Dion Gabriel Lodewijk, Universiteit Utrecht, Utrecht, Utrecht, Netherlands

Dion Gabriel Lodewijk de Martines, MSc

• Laverman, Gozewijn Dirk, Ziekenhuisgroep Twente, Almelo, Overijssel, Netherlands

Gozewijn Dirk Laverman, MD, PhD

• Adema, Aaltje Ymkje, Medisch Centrum Leeuwarden, Leeuwarden, Fryslân, Netherlands

Aaltje Ymkje Adema, MD, PhD

• Luik, Peter T., Stichting Meander Medisch Centrum, Amersfoort, Utrecht, Netherlands

Peter T. Luik, MD, PhD

• Hagen, Ernst C., Stichting Meander Medisch Centrum, Amersfoort, Utrecht, Netherlands

Ernst C. Hagen, MD, PhD

• Fiolet, Aernoud, Universiteit Utrecht, Utrecht, Utrecht, Netherlands

Aernoud Fiolet, MD, PhD

• Gant, Christina Maria, Universiteit Utrecht, Utrecht, Utrecht, Netherlands

Christina Maria Gant, MD, PhD

Group or Team Name

• AKI PATROL Consortium.

Background

Acute Kidney Injury (AKI) complicates 20% of hospital admissions and is associated with prolonged hospital stay, increased mortality and end stage renal disease. Timely guideline based management can prevent further deterioration of kidney function and improve AKI-associated outcomes. Prior research has shown low adherence to these recommendations. Large scale data regarding quality of care are currently lacking. To enhance guideline adherence, understanding the quality of care is of the utmost importance to formulate targeted interventions such as e-alerts or tailored management advice for physicians.

Methods

We conducted a retrospective cohort study in three large teaching hospitals in The Netherlands. Hospitalized patients that developed AKI were included over a period of one year, between January 2022 to October 2023. AKI was identified using an algorithm using KDIGO criteria for serum creatinine (>50%/week or >26µmol/l/48h increase compared to baseline). We logged the occurrence of interventions recommended by the guideline.

Results

2367 episodes of AKI were included. Mean age of patients at AKI was 72 years, 45% were female. AKI was documented in the electronic health record in 70% of cases. Urine tests were performed in 58%, renal imaging conducted in 31%. In 47% of cases, intravenous fluids were started, in 60% nephrotoxic medication was ceased and in 17% a nephrologist was consulted. Anti-hypertensives were ceased in 57%. In 14% of cases patients received iodine contrast during AKI. A follow-up appointment with a nephrologist was made in 10% of patients. Lower adherence rates to KDIGO guideline recommendations were found in surgery wards (such as performing urine diagnostics in 22%, documenting AKI in 65% of cases).

Conclusion

Quality of care for patients with AKI in Dutch hospitals is suboptimal. The most promising targets for improvement of quality of care for patients with AKI are timely recognition of AKI, cessation of antihypertensives and nephrotoxic medication, consultation of a nephrologist, and initiation of fluid therapy. Guideline adherence differed depending on the ward of admission. Tools like an AKI alert may aid in guideline adherence rates.