Document Detail


The impact of documentation of severe acute kidney injury on mortality.
MedLine Citation:
PMID:  24075024     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Modification of the mortality risk associated with acute kidney injury (AKI) necessitates recognition of AKI when it occurs. We sought to determine whether formal documentation of AKI in the medical record, assessed by billing codes for AKI, would be associated with improved clinical outcomes.
METHODS: Retrospective cohort study conducted at three hospitals within a single university health system. Adults without severe underlying kidney disease who suffered in-hospital AKI as defined by a doubling of baseline creatinine (n = 5,438) were included. Those whose AKI was formally documented according to discharge billing codes were compared to those without such documentation in terms of 30-day mortality.
RESULTS: Formal documentation of AKI occurred in 2,325 patients (43%). Higher baseline creatinine, higher peak creatinine, medical admission status, and higher Sequential Organ Failure Assessment (SOFA) score were strongly associated with documentation of AKI. After adjustment for severity of disease, formal AKI documentation was associated with reduced 30-day mortality - OR 0.81 (0.68 - 0.96, p = 0.02). Patients with formal documentation were more likely to receive a nephrology consultation (31% vs. 6%, p < 0.001) and fluid boluses (64% vs. 45%, p < 0.001), and had a more rapid discontinuation of angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker medications (HR 2.04, CI 1.69 - 2.46, p < 0.001).
CONCLUSIONS: Formal documentation of AKI is associated with improved survival after adjustment for illness severity among patients with creatinine-defined AKI.
Authors:
Francis Perry Wilson; Amar D Bansal; Sravan K Jasti; Jennie J Lin; Michael G S Shashaty; Jeffrey S Berns; Harold I Feldman; Barry D Fuchs
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Clinical nephrology     Volume:  80     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-11-22     Completed Date:  2014-03-25     Revised Date:  2014-05-13    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  417-25     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / blood,  drug therapy,  mortality*
Adult
Aged
Cohort Studies
Creatinine / blood
Documentation*
Female
Humans
Male
Middle Aged
Retrospective Studies
Grant Support
ID/Acronym/Agency:
1F32DK093223/DK/NIDDK NIH HHS; F32 DK093223/DK/NIDDK NIH HHS; K23 DK097201/DK/NIDDK NIH HHS; T32 DK007006/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
AYI8EX34EU/Creatinine
Comments/Corrections

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