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. 2024 Jun;46(3):623-630.
doi: 10.1007/s11096-023-01697-4. Epub 2024 Feb 5.

Effects of inpatient creatinine testing frequency on acute kidney injury identification and staging: a historical cohort study

Catarina Luz Oliveira  1   2 , Filipa Duarte-Ramos  1   3 , Filipa Alves da Costa  4 , Fernando Fernandez-Llimos  5
Affiliations

Effects of inpatient creatinine testing frequency on acute kidney injury identification and staging: a historical cohort study

Catarina Luz Oliveira et al. Int J Clin Pharm. 2024 Jun.

Abstract

Background: Acute kidney injury (AKI) is a multifactorial condition often induced by drugs commonly used in hospitals. Identifying and staging AKI necessitates frequent monitoring of renal function.

Aim: To assess the impact of real-world hospital practices regarding serum creatinine (SCr) testing on the identification and staging of AKI, and its implications for adjusting drug doses.

Method: A historical cohort study utilizing hospital records from all adult patients admitted between 01/06/2018 and 31/12/2020 was conducted. Patients with no SCr assessment during their stay or those with an SCr at admission ≥ 2 mg/dL were excluded. AKI was determined using two criteria, namely AKIN and KDIGO, considering the time intervals between two SCr tests as outlined in the criteria. Additionally, patients with SCr increases exceeding AKI limits, regardless the time interval, were also identified. The estimated glomerular filtration rate (eGFR) and kinetic eGFR (KeGFR) were calculated.

Results: During the study period, 17,269 hospitalizations and 62,255 SCr tests were recorded. Among the 17,032 hospitalizations with a length of stay > 48 h, 46.8% experienced periods with no SCr tests performed for more than 48 h. Any stage of AKI was identified in 7.0% of patients and in 9.1% using AKI and KDIGO criteria, respectively. Ignoring time limits in both criteria revealed potential AKI in 1942 patients (11.2%), indicating a potential underdiagnosis of AKI by 37.5% or 19.1%, depending on the criteria used. A total of 76 drugs requiring dose adjustment in patients with eGFR ≤ 50 ml/min were prescribed in 78.5% admissions. These drugs were prescribed in 87.9% of patients potentially underdiagnosed with AKIN and in 88.9% with KDIGO.

Conclusion: There is a need for changes in the established hospital procedures to ensure more frequent testing of SCr levels. Implementing an advanced scope of practice for clinical pharmacists could support these changes.

Keywords: Acute kidney injury; Drug-related side effects and adverse reactions; Hospital; Pharmacoepidemiology; Pharmacy service; Retrospective studies.

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Conflict of interest statement

FAC is associate editor of the International Journal of Clinical Pharmacy but was not involved in the review process of this manuscript. The other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Kinetic estimated glomerular filtration rate (KeGFR) of admissions not identified as with acute kidney injury with AKIN (A) and KDIGO (B) criteria, but with creatinine elevations over the criteria limits
See this image and copyright information in PMC

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