The impact of documentation of severe acute kidney injury on mortality.
OBJECTIVE
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.
Francis Perry
FP
Wilson
Amar D
AD
Bansal
Sravan K
SK
Jasti
Jennie J
JJ
Lin
Michael G S
MG
Shashaty
Jeffrey S
JS
Berns
Harold I
HI
Feldman
Barry D
BD
Fuchs
D058186:Acute Kidney Injury / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004282:Documentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D003404:Creatinine