Laboratory Test Surveillance following Acute Kidney Injury

Background Patients with hospitalized acute kidney injury (AKI) are at increased risk for accelerated loss of kidney function, morbidity, and mortality. We sought to inform efforts at improving post-AKI outcomes by describing the receipt of renal-specific laboratory test surveillance among a large high-risk cohort. Methods We acquired clinical data from the Electronic health record (EHR) of 5 Veterans Affairs (VA) hospitals to identify patients hospitalized with AKI from January 1st, 2002 to December 31st, 2009, and followed these patients for 1 year or until death, enrollment in palliative care, or improvement in renal function to estimated GFR (eGFR) ≥60 L/min/1.73 m2. Using demographic data, administrative codes, and laboratory test data, we evaluated the receipt and timing of outpatient testing for serum concentrations of creatinine and any as well as quantitative proteinuria recommended for CKD risk stratification. Additionally, we reported the rate of phosphorus and parathyroid hormone (PTH) monitoring recommended for chronic kidney disease (CKD) patients. Results A total of 10,955 patients admitted with AKI were discharged with an eGFR<60 mL/min/1.73 m2. During outpatient follow-up at 90 and 365 days, respectively, creatinine was measured on 69% and 85% of patients, quantitative proteinuria was measured on 6% and 12% of patients, PTH or phosphorus was measured on 10% and 15% of patients. Conclusions Measurement of creatinine was common among all patients following AKI. However, patients with AKI were infrequently monitored with assessments of quantitative proteinuria or mineral metabolism disorder, even for patients with baseline kidney disease.

[1]  Mahboob Rahman,et al.  A Simple Tool to Predict End‐Stage Renal Disease within 1 Year in Elderly Adults with Advanced Chronic Kidney Disease , 2013, Journal of the American Geriatrics Society.

[2]  J. Kellum,et al.  Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) , 2013, Critical Care.

[3]  A. Khwaja KDIGO Clinical Practice Guidelines for Acute Kidney Injury , 2012, Nephron Clinical Practice.

[4]  J. Schildcrout,et al.  Estimating baseline kidney function in hospitalized patients with impaired kidney function. , 2012, Clinical journal of the American Society of Nephrology : CJASN.

[5]  Desmond E. Williams,et al.  Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[6]  Liang Li,et al.  Longitudinal progression trajectory of GFR among patients with CKD. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[7]  Chirag R Parikh,et al.  Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. , 2012, Kidney international.

[8]  G. Beck,et al.  Filtration markers may have prognostic value independent of glomerular filtration rate. , 2012, Journal of the American Society of Nephrology : JASN.

[9]  Svetlana K. Eden,et al.  Outpatient nephrology referral rates after acute kidney injury. , 2012, Journal of the American Society of Nephrology : JASN.

[10]  Neil R. Powe,et al.  Is Awareness of Chronic Kidney Disease Associated with Evidence-Based Guideline-Concordant Outcomes? , 2012, American Journal of Nephrology.

[11]  Jonathan Himmelfarb,et al.  Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. , 2011, Clinical journal of the American Society of Nephrology : CJASN.

[12]  Chi-yuan Hsu,et al.  FGF-23 and PTH levels in patients with acute kidney injury: A cross-sectional case series study , 2011, Annals of intensive care.

[13]  B. Astor,et al.  Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury. , 2010, Journal of the American Society of Nephrology : JASN.

[14]  B. Kestenbaum,et al.  KDOQI US commentary on the 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD-Mineral and Bone Disorder (CKD-MBD). , 2010, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[15]  A. Go,et al.  Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. , 2010, Kidney international.

[16]  J. Singh Accuracy of Veterans Affairs Databases for Diagnoses of Chronic Diseases , 2009, Preventing chronic disease.

[17]  A. Macleod,et al.  Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease- Mineral and Bone Disorder (CKD-MBD) , 2009 .

[18]  N. Powe,et al.  Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999–2006 , 2009, Hypertension.

[19]  Amit X Garg,et al.  Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. , 2009, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[20]  C. McCulloch,et al.  Nonrecovery of kidney function and death after acute on chronic renal failure. , 2009, Clinical journal of the American Society of Nephrology : CJASN.

[21]  B. C. Kwan,et al.  Impact of Early Nephrology Referral on Mortality and Hospitalization in Peritoneal Dialysis Patients , 2008, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[22]  A. Go,et al.  The risk of acute renal failure in patients with chronic kidney disease. , 2008, Kidney international.

[23]  Donald R. Miller,et al.  Survival benefit of nephrologic care in patients with diabetes mellitus and chronic kidney disease. , 2008, Archives of internal medicine.

[24]  Daniel C. Brennan,et al.  Delivery patterns of recommended chronic kidney disease care in clinical practice: administrative claims-based analysis and systematic literature review , 2008, Clinical and Experimental Nephrology.

[25]  K. Fletcher,et al.  Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. , 2007, The American journal of medicine.

[26]  M. Fisher,et al.  Adherence to K/DOQI practice guidelines for bone metabolism and disease. , 2007, The American journal of managed care.

[27]  John A Kellum,et al.  Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury , 2007, Critical care.

[28]  G. Eknoyan,et al.  Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). , 2006, Kidney international.

[29]  E. McCarthy,et al.  Declining mortality in patients with acute renal failure, 1988 to 2002. , 2006, Journal of the American Society of Nephrology : JASN.

[30]  Joseph V Bonventre,et al.  Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. , 2005, Journal of the American Society of Nephrology : JASN.

[31]  A. Collins,et al.  General medical care among patients with chronic kidney disease: opportunities for improving outcomes. , 2005, Journal of the American Society of Nephrology : JASN.

[32]  R. Bellomo,et al.  Acute renal failure in critically ill patients: a multinational, multicenter study. , 2005, JAMA.

[33]  A. Collins,et al.  Does predialysis nephrology care influence patient survival after initiation of dialysis? , 2005, Kidney international.

[34]  G. Eknoyan,et al.  Bone metabolism and disease in chronic kidney disease , 2003 .

[35]  Keith C. Norris,et al.  K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[36]  Laurence L. George,et al.  The Statistical Analysis of Failure Time Data , 2003, Technometrics.

[37]  Jerry Avorn,et al.  The nephrologist's role in the management of calcium-phosphorus metabolism in patients with chronic kidney disease. , 2003, Kidney international.

[38]  J. Avorn,et al.  A propensity analysis of late versus early nephrologist referral and mortality on dialysis. , 2003, Journal of the American Society of Nephrology : JASN.

[39]  Ethan M Balk,et al.  K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[40]  G. Remuzzi,et al.  ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy. , 2001, Journal of the American Society of Nephrology : JASN.

[41]  C. Schmid,et al.  Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease. , 2001, Kidney international.

[42]  David Roth,et al.  A simplified equation to predict glomerular filtration rate from serum creatinine , 2000 .

[43]  J. Kalbfleisch,et al.  The Statistical Analysis of Failure Time Data , 1980 .

[44]  Odd Aalen,et al.  Nonparametric Estimation of Partial Transition Probabilities in Multiple Decrement Models , 1978 .

[45]  C. McCulloch,et al.  Temporal changes in incidence of dialysis-requiring AKI. , 2013, Journal of the American Society of Nephrology : JASN.

[46]  B. Satirapoj Nephropathy in diabetes. , 2012, Advances in experimental medicine and biology.

[47]  Gary L Myers,et al.  Validation of CKD and related conditions in existing data sets: A systematic review. , 2011, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[48]  Jonathan Himmelfarb,et al.  Acute kidney injury increases risk of ESRD among elderly. , 2009, Journal of the American Society of Nephrology : JASN.

[49]  Supplemental Tables,et al.  KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). , 2009, Kidney international. Supplement.

[50]  H. Parving,et al.  Nephropathy in diabetes. , 2004, Diabetes care.

[51]  K Doqi,et al.  clinical practice guidelines for chronic kidney disease : evaluation, classification, and stratification , 2002 .

[52]  R. Gray A Class of $K$-Sample Tests for Comparing the Cumulative Incidence of a Competing Risk , 1988 .

[53]  W. G. Walker,et al.  Plasma aldosterone regulation in anephric man. , 1973, Kidney international.