Hospital Harm - Acute Kidney Injury

This measure focuses on acute kidney injury as an outcome in the hospital inpatient setting. Acute kidney injury affects up to 10% of hospitalized patients (Wilson et al., 2015)(Chertow 2005), comparable to the rates of severe sepsis (Hoste, Schurgers, 2008) and acute lung injury (Wilson et al., 2015)(Goldstein et al., 2016)(McCoy et al., 2010). Less severe acute kidney injury and acute kidney injury requiring dialysis affects approximately 2,000 to 3,000 and 200 to 300 per million population per year, respectively. Up to two thirds of intensive care patients will develop acute kidney injury. Acute kidney injury may result in the need for dialysis, and is associated with an increased risk of mortality (Wilson et al., 2013).

While not all instances of acute kidney injury are avoidable and may be due to natural progression of underlying illness or a complication of a necessary treatment such as chemotherapy, a proportion of acute kidney injury cases are preventable and treatable. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest careful management of hemodynamic status, fluids, and vasoactive medications for the prevention of acute kidney injury (Wilson et al, 2015). Several studies identified through systematic literature searches developed or evaluated the effectiveness of acute kidney injury electronic alert systems (Selby et al., 2012; Ahmed et al., 2015; Porter et al., 2014; Wilson et al., 2014; McCoy et al., 2014; Kirkendall et al., 2014; Cho et al., 2012). These studies used data elements for defining acute kidney injury that were already present and populated in the EHR. For acute kidney injury diagnosis, all except two were limited to using serum creatinine levels, suggesting that this is the most reliable and consistently available electronic data element for defining acute kidney injury.