Background and Importance Criteria to identify and stage acute kidney injury (AKI) establish time intervals when the serum creatinine (SCr) should increase to be considered AKI. These intervals range from 48 hours to 7 days (depending on AKIN or KDIGO criteria). Subsequently, a timely SCr test should be performed to inpatients, preferentially no longer than 48 hours.

Aim and Objectives To evaluate the impact of real-world SCr testing hospital practice for the identification and staging of AKI.

Material and Methods A historical cohort study with data from medical records of patients admitted to hospital between 1 June 2018 and 31 December 2020, was conducted. AKI stage was calculated using two criteria: AKIN and KDIGO. Identification and staging were first done considering the time intervals when the SCr increase should be identified as described in the two criteria. Then, a second staging process was conducted ignoring the time intervals and considering all the hospitalisation time. Length of stay (LoS) was calculated by adding 1 day to the difference between discharge and admission dates. Creatinine clearance was estimated using the Cockcroft-Gault equation. A list of drugs that require dose adjustment when CrCl achieves 50 mL/min was obtained from the Renal Drug Handbook 3rd edition.

Results During the study period, 17,269 hospitalisations and 62,255 SCr tests were recorded. Among the 17,032 hospitalisations with LoS >48h, 46.8% presented periods >48h with no SCr tests performed. In 3.5% of hospitalisations the patient’s weight was not registered. Any stage of AKI was identified in 7.0% and in 9.1% of patients using AKI and KDIGO criteria, respectively. When ignoring time limits in both criteria, potential AKI could have occurred in 1,942 patients (11.2%). A total of 76 different drugs requiring dose adjustment in patients with eGFR ≤50 ml/min were prescribed in 78.5% admissions, and 30.3% of all admissions included patients prescribed with these drugs that reached eGFR <50 ml/min.

Conclusion and Relevance Our study suggests that real-world SCr testing hospital practice for the identification and staging of acute kidney injury may not be sufficient to identify all the AKI occurrences. Organisational or legal changes are necessary to contribute to timely use of analytic values to optimise therapy and thus increase patient safety.

References and/or Acknowledgements 1. KDIGO Clinical Practice Guidelines For Acute Kidney Injury. KidneyIntSuppl[Internet]. 2012;2:138.

2. 2. The Renal Drug Handbook ISBN-13:9781846192982.

3. Lagreula J, et al. Optimizing pharmacists’detection of prescribing errors: comparison of on-ward and central pharmacy services. JclinPharmTher. 2021;46:738–43.

Conflict of Interest No conflict of interest.