title: Enhanced creatinine and estimated glomerular filtration rate reporting to facilitate detection of acute kidney injury.
abstract: OBJECTIVE
  While acute kidney injury (AKI) can be diagnosed based on specified increases in a patient's plasma creatinine level, standard creatinine reporting methods typically only flag creatinine results as abnormal when outside the reference range and often fail to identify rising creatinine values indicative of AKI. Here, we evaluate the impact of this limitation in standard creatinine reporting and develop and implement an enhanced creatinine reporting algorithm.
  
  
  METHODS
  We evaluated 59,712 plasma creatinine results collected over approximately 3 months, using computational simulations and statistical analyses.
  
  
  RESULTS
  Our analyses demonstrated that 29% of creatinine results substantially increased over the patient's baseline and concerning for AKI remained within the normal reference range. These concerning results would not be flagged as abnormal using standard reporting. Likewise, we found that simple delta checks are also insensitive at AKI detection. To improve creatinine reporting, we developed and implemented an algorithm within our laboratory information system to alert clinicians to rising creatinine results, which we describe in this report.
  
  
  CONCLUSIONS
  While both creatinine reference limits and simple delta checks are insensitive for AKI identification, a simple algorithm can be implemented within a common laboratory information system to enhance AKI identification.
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, MA;
authors.forename: Jason M
authors.initials: JM
authors.lastname: Baron
authors.affiliation: Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston; and.
authors.forename: Xingxing S
authors.initials: XS
authors.lastname: Cheng
authors.affiliation: Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston; and Division of Nephrology, Massachusetts General Hospital, Boston.
authors.forename: Hasan
authors.initials: H
authors.lastname: Bazari
authors.affiliation: Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston; and Division of Nephrology, Massachusetts General Hospital, Boston.
authors.forename: Ishir
authors.initials: I
authors.lastname: Bhan
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital, Boston;
authors.forename: Christopher
authors.initials: C
authors.lastname: Lofgren
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital, Boston;
authors.forename: Rosemary T
authors.initials: RT
authors.lastname: Jaromin
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, MA;
authors.forename: Kent B
authors.initials: KB
authors.lastname: Lewandrowski
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, MA; asdighe@partners.org.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Dighe
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D000465:Algorithms; D002984:Clinical Laboratory Information Systems; D003198:Computer Simulation; D003404:Creatinine / Q000097:blood*; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans
chemical_list: D003404:Creatinine
keywords: Acute kidney injury (AKI); Creatinine; Diagnostic error; Estimated glomerular filtration rate (eGFR)