Acute kidney injury risk assessment at the hospital front door: what is the best measure of risk?

Abstract

BackgroundWe examined the prevalence of acute kidney injury (AKI) risk factors in the emergency medical unit, generated a modified risk assessment tool and tested its ability to predict AKI.MethodsA total of 1196 patients admitted to medical admission units were assessed for patient-associated AKI risk factors. Subsequently, 898 patients were assessed for a limited number of fixed risk factors with the addition of hypotension and sepsis. This was correlated to AKI episodes.ResultsIn the first cohort, the prevalence of AKI risk factors was 2.1 ± 2.0 per patient, with a positive relationship between age and the number of risk factors and a higher number of risk factors in patients ≥65 years. In the second cohort, 12.3% presented with or developed AKI. Patients with AKI were older and had a higher number of AKI risk factors. In the AKI cohort, 72% of the patients had two or more AKI risk factors compared with 43% of the cohort with no AKI. When age ≥65 years was added as an independent risk factor, 84% of those with AKI had two or more AKI risk factors compared with 55% of those with no AKI. Receiver operating characteristic analysis suggests that the use of common patient-associated known AKI risk factors performs no better than age alone as a predictor of AKI.ConclusionsDetailed assessment of well-established patient-associated AKI risk factors may not facilitate clinicians to apportion risk. This suggests that additional work is required to develop a more sensitive validated AKI-predictive tool that would be useful in this clinical setting.

The Combined Effect of High Ambient Temperature and Antihypertensive Treatment on Renal Function in Hospitalized Elderly Patients

“…Relevant predicting factors may include age, volemic state, underlying kidney function, diabetes mellitus and CHF, all proven to be associated with future AKI. The additive effects of those factors have been partially tested in previous studies [10,32,33]. In the current study we further expand this concept by showing a novel effect of high temperature on creatinine increment in addition to the age and medications.…”

Risk prediction for acute kidney injury in acute medical admissions in the UK

“…The large number of risk factors, many of which are very common, means that a very high percentage of medical patients admitted to hospital have at least one of these. 80% of general medical patients over the age of 60 have been reported to have at least one AKI risk factor in addition to age alone, consequently this approach does not allow reliable discrimination between those at low and higher risk (10).…”

Serum uric acid and AKI: is it time?

“…No AKI prediction model has been developed for hospitalized patients thus far. Furthermore, in a recent publication in this journal, Roberts et al have failed to show that a predictive model based on well-established patient-associated factors could facilitate clinicians in apportioning risk of AKI in patients admitted to an emergency unit [ 25 ]. Thus it is open to speculation whether the addition of certain biochemical parameters and/or biomarkers may improve the specificity of such a predictive model.…”