Assessing the accuracy of ICD-10 coding for measuring rates of and mortality from acute kidney injury and the impact of electronic alerts: an observational cohort study

Logan, Rachael; Davey, Peter; Souza, Nicosha De; Baird, David; Guthrie, Bruce; Bell, Samira

doi:10.1093/ckj/sfz117

Cited by 32 publications

(20 citation statements)

References 33 publications

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“…They did not use a biochemical definition for AKI and relied instead on clinical coding, which can lead to significant underascertainment. 29 In addition, a meta-analysis by James et al 30 showed the hazards ratios for AKI were higher in participants with diabetes compared with those without diabetes at any level of eGFR. Once again, the definition for AKI relied on administrative codes in these studies, thereby underestimating milder forms of AKI.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

Hapca

Siddiqui

Kwan

et al. 2020

JASN

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BackgroundThere are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population.MethodsIn this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline.ResultsWe followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD.ConclusionsPatients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.

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Section: Discussionmentioning

confidence: 99%

The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

Hapca

Siddiqui

Kwan

et al. 2020

JASN

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“…Acute kidney injury (AKI) is a common and devastating pathologic condition in part due its higher incidence in the elderly and its association with an increased short- and long-term mortality ( Levey and James, 2017 ; Hounkpatin et al, 2019 ; Martin-Cleary et al, 2019 ; Logan et al, 2020 ). Moreover, AKI is closely related to chronic kidney disease (CKD) as AKI may accelerate CKD progression to end-stage renal disease (ESRD) and CKD predisposes to AKI ( Venkatachalam et al, 2015 ; Siew et al, 2016 ; Ruiz-Ortega et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury is Aggravated in Aged Mice by the Exacerbation of Proinflammatory Processes

et al. 2021

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Acute kidney injury (AKI) is more frequent in elderly patients. Mechanisms contributing to AKI (tubular cell death, inflammatory cell infiltration, impaired mitochondrial function, and prolonged cell-cycle arrest) have been linked to cellular senescence, a process implicated in regeneration failure and progression to fibrosis. However, the molecular and pathological basis of the age-related increase in AKI incidence is not completely understood. To explore these mechanisms, experimental AKI was induced by folic acid (FA) administration in young (3-months-old) and old (1-year-old) mice, and kidneys were evaluated in the early phase of AKI, at 48 h. Tubular damage score, KIM-1 expression, the recruitment of infiltrating immune cells (mainly neutrophils and macrophages) and proinflammatory gene expression were higher in AKI kidneys of old than of young mice. Tubular cell death in FA-AKI involves several pathways, such as regulated necrosis and apoptosis. Ferroptosis and necroptosis cell-death pathways were upregulated in old AKI kidneys. In contrast, caspase-3 activation was only found in young but not in old mice. Moreover, the antiapoptotic factor BCL-xL was significantly overexpressed in old, injured kidneys, suggesting an age-related apoptosis suppression. AKI kidneys displayed evidence of cellular senescence, such as increased levels of cyclin dependent kinase inhibitors p16ink4a and p21cip1, and of the DNA damage response marker γH2AX. Furthermore, p21cip1 mRNA expression and nuclear staining for p21cip1 and γH2AX were higher in old than in young FA-AKI mice, as well as the expression of senescence-associated secretory phenotype (SASP) components (Il-6, Tgfb1, Ctgf, and Serpine1). Interestingly, some infiltrating immune cells were p21 or γH2AX positive, suggesting that molecular senescence in the immune cells (“immunosenescence”) are involved in the increased severity of AKI in old mice. In contrast, expression of renal protective factors was dramatically downregulated in old AKI mice, including the antiaging factor Klotho and the mitochondrial biogenesis driver PGC-1α. In conclusion, aging resulted in more severe AKI after the exposure to toxic compounds. This increased toxicity may be related to magnification of proinflammatory-related pathways in older mice, including a switch to a proinflammatory cell death (necroptosis) instead of apoptosis, and overactivation of cellular senescence of resident renal cells and infiltrating inflammatory cells.

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“…It is worth mentioning that different definitions of AKI would affect the number of AKI cases and utilization rate of dialysis-requiring AKI. Several studies have showed inadequate validity and accuracy of using ICD discharge coding to identify AKI 22 – 25 . Despite SCr-based defined AKI is a relatively new concept to allow early identification and prevention of patients at risk for AKI, we found ICD-9 discharge coding for AKI were sensitive to hospitalized patients with more severe stage of SCr-based defined AKI 23 .…”

Section: Discussionmentioning

confidence: 99%

Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010–2017

Tain

Kuo

Hsu

2021

Sci Rep

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The aim of the study was to assess trends in the relative use of dialysis modalities in the hospital-based pediatric cohort and to determine risk factors associated with in-hospital morality among pediatric patients receiving dialysis for acute kidney injury (AKI). Patients aged < 20 years who received dialysis between 2010 and 2017 were identified from electronic health records databases of a Taiwan’s healthcare delivery system. The annual uses of intermittent hemodialysis (HD), continuous and automated peritoneal dialysis (PD) and continuous kidney replacement therapy (CKRT) were assessed using Cochran-Armitage Tests for trend. Among patients who received their first dialysis as inpatients for AKI, a multivariate logistic regression model was employed to assess mortality risks associated with dialysis modalities, patient demographics, complexity of baseline chronic disease, and healthcare service use during their hospital stays. Kidney dialysis was performed 37.9 per patient per year over the study period. Intermittent hemodialysis (HD) (73.3%) was the most frequently used dialysis modality. In the inpatient setting, the relative annual use of CKRT increased over the study period, while HD use concomitantly declined (P < 0.0001). The overall in-hospital mortality rate after dialysis for AKI was 33.6%, which remained steady over time (P = 0.2411). Patients aged < 2 years [adjusted odds ratio: (aOR) 3.36; 95% confidence interval (CI) 1.34–8.93] and greater vasoactive regimen use (aOR: 17.1; 95% CI: 5.3–55.21) were significantly associated with dialysis-related mortality. Overall treatment modality used for dialysis in pediatric patients increased slowly in the study period, and HD and CRKT modality uses largely evolved in the inpatient setting. Younger ages and use of more vasoactive medication regimens were independently associated with increased early mortality in patients on AKI-dialysis.

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Assessing the accuracy of ICD-10 coding for measuring rates of and mortality from acute kidney injury and the impact of electronic alerts: an observational cohort study

Cited by 32 publications

References 33 publications

The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

Acute Kidney Injury is Aggravated in Aged Mice by the Exacerbation of Proinflammatory Processes

Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010–2017

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