Under‐detection of acute kidney injury in hospitalised patients: a retrospective, multi‐site, longitudinal study

Abstract

Background Acute kidney injury (AKI) is a rapid deterioration of renal function, often caused by a variety of co‐existing morbidities complicating its recognition and treatment, leading to short‐ and long‐term adverse clinical outcomes. There are limited data on the incidence of AKI in Australia using the Kidney Disease Improving Global Outcomes creatinine‐based consensus definition. Aim To determine the incidence and estimate the extent of under‐reporting of AKI in four hospitals in the South‐Eastern Sydney/Illawarra regions of New South Wales, Australia. Method A laboratory algorithm based on the Kidney Disease Improving Global Outcomes creatinine‐based definition for AKI was applied retrospectively to laboratory data for adult patients admitted to the study hospitals between 2009 and 2013 to identify those with AKI. The results were compared with the incidence of AKI based on diagnostic codes for AKI reported for the same period. Results AKI was detected in 12.4% of all hospitalisations (46 101/370 969) and 16.4% of patients (31 448/192 133) across the 5‐year study period using the laboratory algorithm. Of these, 72.1% were AKI Stage 1 (33 246/46101). AKI was coded in only 15.9% of hospitalisations with AKI Stage 1 (5294/33 246), 38.5% of hospitalisations with Stage 2 (2381/6185), and 46.8% with Stage 3 (3120/6670). Yearly incidence of laboratory‐identified AKI trended downward between 2009 and 2013, while annual incidence determined by coding trended upward. Conclusion Although coding trends suggested a continuous increase in clinician awareness of AKI across the study period, AKI in hospitalised patients remained significantly under‐reported.

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

“…A recently published study by Campbell et al . [ 34 ], which looked to determine the extent of under-reporting of AKI using the ICD-10-AM (Australian Modification) in four Australian hospitals, found there to be a poor sensitivity of the ICD-10-AM codes for picking up AKI, improving for more severe AKI cases [ 34 ], which supports the findings of our study. Siew and Davenport .…”

Diagnostic Informatics—The Role of Digital Health in Diagnostic Stewardship and the Achievement of Excellence, Safety, and Value

“…As an example of the potential of outcome focused studies to impact on patient care, we investigated the incidence of acute kidney injury (AKI) over a 5-year period (2009–2013) across four NSW hospitals ( 11 ). Patients with AKI were identified using the serum creatinine-based definition as described in the international consensus guidelines published by the “Kidney Disease: Improving Global Outcomes” (KDIGO) Work Group.…”

The kinetic estimated glomerular filtration rate ratio predicts acute kidney injury

“…We hypothesised that a change in KeGFR would detect AKI earlier than the change in serum creatinine needed to trigger AKI diagnosis and assessed this in a retrospective analysis of a general hospital cohort of subjects who developed AKI in our hospital where an AKI eAlert is now deployed 19 . The primary outcome was the performance of the KeGFR Ratio, the ratio of the difference between KeGFR and baseline eGFR divided by the baseline eGFR, in predicting AKI.…”