MUNZNER E1, MULLAN J1,2, LAMBERT K1,7, LONERGAN M1,3, SUESSE T4,5, MCALISTER B6, CHEIKH HASSAN H1,3
1School Of Medicine, University Of Wollongong, Wollongong, Australia, 2Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, Australia, 3Department of Nephrology, Wollongong Hospital, Wollongong, Australia, 4National Institute for Applied Statistics Research Australia, Wollongong, Australia, 5School of Mathematics and Applied Science, University of Wollongong, Wollongong, Australia, 6Illawarra Shoalhaven Local Health District, , Australia, 7Illawarra Health and Medical Research Institute, Wollongong, Australia
Aim: This study aimed to determine the prevalence and trends of acute kidney injury (AKI) in the Illawarra Shoalhaven Local Health District (ISLHD) over a 10-year period using pathology and administrative data.
Background: The ISLHD has the highest prevalence of chronic kidney disease (CKD) in Australia. AKI is a known risk factor for development of CKD. Prevalence of AKI can be determined by applying diagnostic criteria to pathology values or by examining administrative data for international classification of diseases (ICD-10) codes for AKI.
Methods: We applied the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria to a retrospective, longitudinal pathology dataset of adult (>18 years of age) patient encounters from ISLHD inpatients, Emergency department patients and outpatients between January 2007 and December 2017. Annual rates and trends of ICD-10 coding for AKI were examined and compared to total AKI rates.
Results: A total of 150,140 patients were included. AKI occurred in 24,616 (16%) patients over the 10-year study period. The annual increase in AKI was 2.3% (95% CI 2.0 to 4.4, P<0.05). In the same period only 9% of patients had an AKI diagnosis as per ICD-10. Overall, there was improvement in coding rates (+8.1%, 95% CI 4.6 to 11.8, P<0.05), however this was not significant in the latter five years of the study (+2.3%, 95% CI, -0.2 to 5.7, P = 0.1).
Conclusions: Increasing rates of AKI in the ISLHD are concerning and could be a contributing factor to higher CKD rates reported in this region. Recognition of AKI in medical notes has improved overall, however increased vigilance is needed as reporting rates plateaued in the latter years of the study.
Eyra Munzner is a final year medical student at the University of Wollongong, NSW Australia. Prior to completing her medical degree she was a hospital pharmacist. She has worked as a pharmacist in NSW hospitals since 2011. Her clinical interest areas include renal medicine, emergency medicine, toxicology, pharmacology and pharmacotherapeutics.