Abstract: SA-PO029
Health Care Provider Awareness of AKI in Patients with Advanced CKD Undergoing Surgery: A Descriptive Study of Preoperative Notes
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
- Buckstein, Jonah, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Hammond, Sarah M., Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Harrison, Tyrone, University of Calgary, Calgary, Alberta, Canada
- Silver, Samuel A., Kingston Health Sciences Centre, Kingston, Ontario, Canada
Background
Postoperative acute kidney injury (AKI) is a frequent complication of surgery, with an incidence of 18-47%. The KDIGO guidelines offer a bundle of preventative strategies to mitigate AKI risk. Our study examined how often the risk of AKI and elements of the KDIGO bundle were mentioned by healthcare providers in their preoperative notes.
Methods
We retrospectively identified patients ≥ 18 years followed in a tertiary care advanced chronic kidney disease (CKD) clinic who underwent elective surgery with a preoperative anesthesia assessment between January 1, 2017 and December 31, 2022. We extracted data on provider awareness of AKI, inclusion of KDIGO bundle elements in preoperative assessments, and qualitative comments on AKI risk assessment. We analyzed the quantitative data descriptively, stratifying our findings by preoperative healthcare provider awareness of AKI. We used a constant comparison technique and consensus to analyze qualitative comments.
Results
Of 91 patients, the mean age was 76 (±13) years, 75% were male, and 96% had category 4 or 5 CKD. Postoperative AKI and dialysis frequencies were 13% and 1%, respectively. Few anesthesia providers (n=22/91, 24%) mentioned the risk of postoperative AKI. The most commonly documented KDIGO recommendations included holding ACEi/ARB medications (n=15/21, 80%), obtaining a preoperative creatinine measure (n=66/91, 73%), and considering hemodynamic monitoring (n=28/91, 31%). The least mentioned KDIGO recommendations included avoiding radiocontrast media (n=0/91, 0%), controlling hyperglycemia (n=2/91, 2%), and documenting the need for a postoperative creatinine (n=2/91, 2%). There was no difference in the inclusion of KDIGO bundle elements when stratifying preoperative awareness of AKI. In qualitative comments, providers who recognized postoperative AKI risk frequently mentioned the potential for dialysis (n=12/22, 55%), rarely utilized risk scores (n=1/22, 5%), and did not provide any actionable postoperative orders (n=0/22, 0%).
Conclusion
Among patients with advanced CKD, only 24% of anesthesia providers mentioned the risk of AKI in their pre-operative assessments. Opportunities may exist to improve the perioperative care of patients with advanced CKD by increasing awareness of AKI risk and the KDIGO bundle elements.