Dr Wayne Thai1, Professor Eugenia Pedagogos1,2,3, A/Prof Craig Nelson1,2,3, Dr Hannah Wallace1,2,3
1Department of Nephrology, Western Health, Melbourne, Australia, 2Faculty of Medicine and Health, University of Melbourne, Melbourne, Australia, 3Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia
Biography:
Bio to come
Aim:
To review discharge documentation of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), sodium-glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRA), in General Medical patients with an Acute Kidney Injury (AKI).
Background:
ACEi/ARB, SGLT2i and MRA are important in managing cardio-kidney-metabolic disease. Discharge documentation regarding recommencement post AKI is essential.
Methods:
This was a retrospective observational study of adults admitted to General Medicine with AKI at a tertiary centre from 01/06/2023-31/08/2023. AKI was defined as an increase in serum creatinine of 26.5μmol/L in 48hours or ≥1.5 times baseline. Medical records were reviewed for discharge documentation of AKI and recommencement recommendations of ACEi/ARB, SGLT2i and MRA if withheld.
Results:
437 patients with an AKI were included with an average age of 73.9 years (SD 15.4). AKI was documented in 42.3% of discharge summaries, with higher completion in increasing severity (stage I 37.4%, stage II 49.4% and stage III 84.6%, p<0.001). 43.7% of patients were taking an ACEi/ARB at admission. Of the 64.4% who had ACEI/ARB withheld, 41.5% were recommenced, 25.2% recommended General Practitioner (GP) review and 22.8% had no documentation. Only 8.1% of patients were on an SGLT2 inhibitor. Of the 74.2% with SGTL2i withheld, 50% were recommenced, 7.7% for GP review and 30.8% had no documentation. MRA was prescribed in 16.5% of patients, 39.2% had it withheld, and of these, 50.0% were recommenced, 20.0% for GP review and 16.8% had no documentation. Medications marked for GP review lacked details on timing and restart criteria in over 50% of cases.
Conclusions:
There are substantial opportunities to improve documentation of AKI and GP recommendations for restarting cardio-kidney-metabolic medications in the discharge summary.