Acute kidney injury and its progression in hospitalized patients—Results from a retrospective multicentre cohort study with a digital decision support system

Abstract

In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.

Incidence of hospital contacts with acute kidney injury after initiation of second-generation antipsychotics in older adults: a Danish population-based cohort study

“…However, we did not use serum creatinine values due to the unavailability of nationwide laboratory data covering the entire study period. As a result, the current study's AKI identification method using ICD-10 codes includes severe cases of AKI but not mild to moderate cases, hence may have poor sensitivity but the diagnosis is known to have high specificity [17,35]. Regardless of the large study population, this low sensitivity of AKI diagnosis could have led to potential underestimation of AKI event rates and wider CIs.…”

“…We performed pre-planned sensitivity analyses with follow-ups of 180 days and 1 year to check for changes in risk over time [19]. Due to inadequate sensitivity to detect AKI diagnosis using ICD-10 codes [17,35], additional analysis was performed with dialysis as outcome using SKS codes: BJFD00 (acute intermittent hemodialysis), BJFD01 (acute peritoneal dialysis), BJFD02 (continuous renal replacement therapy), and BJFD0 (unspecified acute dialysis) [15].…”

“…This also reflected increased dialyses in patients aged > 75 [15]. AKI is common in hospital admissions among older adults with a prevalence of 9.7-12.1% [16,17]. Among intensive care patients, 1-year mortality rates among older adults with AKI are much higher (48.7-57.4%) than in patients without AKI (22.1%) [18].…”

Laboratory diagnostic of acute kidney injury and its progression: risk of underdiagnosis in female and elderly patients

“…In particular, progressive AKI, to date a less studied phenomenon, has a strong prognostic value and negative clinical course. The general importance of timely detection and adequate treatment of progression has already been described in a previous study [3]. To the best of our knowledge, this study is the first to analyze sex and age differences in the laboratory-based diagnosis of progressive AKI using a recalculation based on the eGFR to convert SCr for opposite sex and age groups, clearly illustrating the risk of underdiagnosis in female and elderly patients.…”

“…Associations with increased short- and long-term mortality rates, longer lengths of hospitalization, and higher rates of renal replacement therapy have been observed in several studies [1,3–5]. In particular, the progression of AKI to a higher stage according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines is associated with significantly worse outcomes, such as higher rates of mortality and renal replacement therapy [3]. In recent years, interest in the implementation of electronic information and alert systems to support decision making by physicians has generally increased [6].…”