title: Laboratory test surveillance following acute kidney injury.
abstract: BACKGROUND
  Patients with hospitalized acute kidney injury (AKI) are at increased risk for accelerated loss of kidney function, morbidity, and mortality. We sought to inform efforts at improving post-AKI outcomes by describing the receipt of renal-specific laboratory test surveillance among a large high-risk cohort.
  
  
  METHODS
  We acquired clinical data from the Electronic health record (EHR) of 5 Veterans Affairs (VA) hospitals to identify patients hospitalized with AKI from January 1st, 2002 to December 31st, 2009, and followed these patients for 1 year or until death, enrollment in palliative care, or improvement in renal function to estimated GFR (eGFR) ≥ 60 L/min/1.73 m(2). Using demographic data, administrative codes, and laboratory test data, we evaluated the receipt and timing of outpatient testing for serum concentrations of creatinine and any as well as quantitative proteinuria recommended for CKD risk stratification. Additionally, we reported the rate of phosphorus and parathyroid hormone (PTH) monitoring recommended for chronic kidney disease (CKD) patients.
  
  
  RESULTS
  A total of 10,955 patients admitted with AKI were discharged with an eGFR<60 mL/min/1.73 m2. During outpatient follow-up at 90 and 365 days, respectively, creatinine was measured on 69% and 85% of patients, quantitative proteinuria was measured on 6% and 12% of patients, PTH or phosphorus was measured on 10% and 15% of patients.
  
  
  CONCLUSIONS
  Measurement of creatinine was common among all patients following AKI. However, patients with AKI were infrequently monitored with assessments of quantitative proteinuria or mineral metabolism disorder, even for patients with baseline kidney disease.
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, United States of America; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America; Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Matheny
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America; Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Josh F
authors.initials: JF
authors.lastname: Peterson
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Svetlana K
authors.initials: SK
authors.lastname: Eden
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, United States of America; Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Hung
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, United States of America; Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdel-Kader
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Sharidan K
authors.initials: SK
authors.lastname: Parr
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology*; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D063868:Patient Outcome Assessment; D010758:Phosphorus / Q000097:blood; D011507:Proteinuria / Q000175:diagnosis; D062486:Public Health Surveillance; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D003404:Creatinine