REVIEW OF AKI MANAGEMENT IN HOSPITALISED PATIENTS REFERRED FOR NEPHROLOGY CONSULT
SOPHIE O’BRIEN1, NICHOLAS ADAMS1, ISAAC TANG1, CRAIG NELSON1,2, HANNAH WALLACE1,2,3
1Western Health, Australia, 2Faculty of Medicine and Health, University of Melbourne, Australia, 3Centre for Digital Transformation of Health, University of Melbourne, Australia
Aim: To review acute kidney injury (AKI) management in hospitalised patients referred to nephrology.
Background: Acute kidney injury (AKI) complicates up to 1 in 5 hospital admissions, and is associated with increased length of stay and mortality. AKI is a common reason for referral for nephrology consult for non-nephrology inpatients.
Methods: This was a retrospective observational study of all patients with AKI referred to the nephrology consults service at a tertiary centre from 1 March to 31 August 2023. AKI was defined as an increase in serum creatinine by 26.5umol/L in 48 hours or >1.5 times baseline within 7 days. File review was conducted for patient characteristics, investigations, AKI management and renal related outcomes. Best practice care was defined as documentation of AKI, review of nephrotoxic agents, fluid review, fluid balance charting, repeat creatinine, bladder scan or renal tract imaging, and urinalysis being completed within 24 hours of AKI occurring.
Results: 258 patients were referred to nephrology, of which 126 (49%) had AKI. In patients with AKI, the median age was 68, with a male predominance (55%), and a median Charlson comorbidity index of 6 (IQI 3-7). Stage 3 AKI was most common (50.4%). The median length of stay was 14 days (IQI 8-23) and 14.3% died during admission. In relation to AKI care, median time to referral was 2 days (IQI 1-4); and 16.7% had all aspects of AKI care initiated within 24 hours. 17.1% did not have the AKI event documented in the discharge summary.
Conslusion: In this retrospective review of inpatient nephrology referrals, only 16.7% of patients met our composite outcome for best practice. Ongoing efforts are required to improve AKI care.