Study Highlights Need for Earlier AKI Diagnosis

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SAN DIEGO—New findings presented at Kidney Week 2012 underscore the need for continued improvement in the recognition and management of patients with acute kidney injury (AKI) during and following hospital admission.

Brittany E. Yee, a medical student at the University of California-San Diego, and colleagues reviewed the charts of 100 patients discharged with an ICD-9 diagnosis of AKI and 190 matched controls who did not have an ICD-9 diagnosis.

All patients with an ICD-9 code for AKI were confirmed to have AKI, but only 38% met the standard Acute Kidney Injury Network (AKIN) criteria. Interestingly, Yee noted, 26% of the patients without an ICD-9 code for AKI actually did have AKI, with only 8.9% meeting standard AKIN criteria.

“This reaffirms what we see in the literature that ICD-9 codes are always a reliable means of diagnosing patients with AKI,” Yee said.

Patients with ICD-9 codes for AKI more typically received urinalysis and electrolyte studies, and more often had their medications renally dosed than those who did not have ICD-9 codes for AKI, Yee said.

Within the first year, patients with an ICD-9 code for AKI had a significantly greater frequency of subsequent AKI compared with patients who did not have an ICD-9 code for AKI (59.4% vs. 22.3%); they also had a significantly increased rate of progression to end-stage renal disease (7.8% vs. 0.6%). Readmission and mortality rates did not differ significantly. Only 23.4% of patients with an ICD-9 code for AKI followed up with a nephrologist post-discharge

AKI diagnoses and interventions need to occur sooner, and patients with AKI require better follow-up, Yee said.

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