DN TRAN1, PG KERR1.
1Monash Health, Clayton, Victoria
Aim: To determine the prevalence of renal impairment (chronic or acute) in adult inpatients across Monash Health, the largest metropolitan health service in Victoria, and the use of appropriate investigations for acute kidney injury.
Background: There has been an increase in the prevalence of chronic kidney disease in Australia. Likewise, it has been shown that acute kidney injury, even with increases in serum creatinine as little as 26.4 µmol/L, is associated with increased mortality.
Methods: We performed a retrospective analysis of 671 adults who were acute inpatients in 4 hospitals across Monash Health on the 14th of December 2016. Patients who had a serum creatinine >100µmol/L or eGFR <60ml/min during their admission were identified as having abnormal renal function. Data regarding baseline renal function, relevant comorbidities, investigations and documentation of AKI (defined as an increase in serum creatinine by >26.5 µmol/L from baseline) were obtained.
Results: Of the total 671 patients analysed, 240 patients (35.8%) had abnormal renal function during their admission. Of these, 107 (15.9%) were known to have abnormal renal function as a baseline while 133 (19.8%) had either normal or unknown baseline renal function. 167 patients (24.9%) had acute kidney injury. Of these patients, 13.8% underwent renal imaging, 66.5% had urine sent for microscopy, 15.6% for active sediment, and 24.6% for protein/creatinine ratio. A diagnosis of AKI was documented in 62.3% of these patients.
Conclusions: Renal impairment, both chronic and acute, has a significant prevalence in the population of acute inpatients. Acute kidney injury appears to be under-recognised and a greater focus on identifying and appropriately managing these patients is warranted given the association of AKI with mortality and long term CKD.