title: Undiagnosed kidney disease in hospitalised patients: an opportunity for improvement.
abstract: OBJECTIVE
  In hospitalised patients, chronic kidney disease (CKD) is associated with a high risk of morbidity, mortality and drug toxicity. We identified care improvement opportunities in hospitalised patients with kidney disease in a regional hospital.
  
  
  METHODS
  Clinical audit: 200 patients hospitalised for any reason in Alcañiz Hospital (Spain) were randomly selected. The data sources were laboratory data, clinical history and discharge reports. RIFLE criteria were applied to define kidney function deterioration. As process quality indicators we used: 1) percentage of hospitalised patients with at least one determination of kidney function during admission. 2) percentage of patients who met criteria for CKD and/or kidney function deterioration and who had this diagnosis recorded in clinical progress reports. 3) percentage of patients who met criteria for CKD and/or kidney function deterioration and who had this diagnosis recorded in the discharge report.
  
  
  RESULTS
  Mean age was 71.1 (17) years, 42% women, 63% admitted to medical areas and 37% to surgical areas. Some 194 patients had a kidney function determination at admission; however during their stay kidney function was not monitored in 54 patients (27%), especially in surgical areas. CKD diagnosis by analyses prior to admission was available for 50 patients (25%); however this diagnosis figures in the clinical history in 14 of them (28%), and in the discharge report in 17 (34%). Kidney function deterioration was detected in 68 of the 146 patients who had kidney function monitoring during hospitalisation (46.5%). This information was contained in the clinical history in only 50% of cases and in the discharge report in 33.8%.
  
  
  CONCLUSIONS
  The incidence of CKD prior to admission and deterioration of kidney function during hospitalisation are high. Often these diagnoses are not included in clinical progress reports or in the discharge report, reflecting poor condition awareness on the part of our colleagues. Implementation of a clinical protocol and its diffusion throughout the hospital may be important tools to achieving more efficient and consistent management of these conditions.
authors.affiliation: Internal Medicine Department, Hospital de Alcañiz, Teruel, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Campos Gutiérrez
authors.forename: L M
authors.initials: LM
authors.lastname: Lou Arnal
authors.forename: J A
authors.initials: JA
authors.lastname: Gimeno Orna
authors.forename: O
authors.initials: O
authors.lastname: Gracia García
authors.forename: M
authors.initials: M
authors.lastname: Cuberes Izquierdo
authors.forename: J M
authors.initials: JM
authors.lastname: Turón Alcaine
authors.forename: L
authors.initials: L
authors.lastname: Arnaudas Casanova
authors.forename: B
authors.initials: B
authors.lastname: Boned Juliani
authors.forename: S
authors.initials: S
authors.lastname: Bielsa García
authors.forename: Alberto
authors.initials: A
authors.lastname: Sanjuán Hernández-French
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006753:Hospital Records; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D033162:Incidental Findings; D007297:Inpatients; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D012494:Sampling Studies; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003404:Creatinine