Laboratory Test Surveillance following Acute Kidney Injury

BackgroundPatients 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.MethodsWe 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 m2. 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.ResultsA total of 10,955 patients admitted with AKI were discharged with an eGFR2. 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.ConclusionsMeasurement 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.背景：住院急性肾损伤（acute kidney injury, AKI）患者发生肾功能加速丧失、并发症及死亡的风险显著升高。本研究通过描述大型高危队列中肾脏特异性实验室检测监测的实施情况，以期为改善AKI患者出院后转归提供循证依据。 方法：本研究从5家退伍军人事务部（Veterans Affairs, VA）医院的电子健康档案（Electronic health record, EHR）中提取临床数据，筛选2002年1月1日至2009年12月31日期间住院的AKI患者，并对其开展为期1年的随访，随访终点包括患者死亡、纳入姑息治疗，或肾功能改善至估算肾小球滤过率（estimated GFR, eGFR）≥60 L/min/1.73 m²。研究利用人口统计学资料、行政编码数据及实验室检测结果，评估了慢性肾脏病（chronic kidney disease, CKD）风险分层推荐的血清肌酐、定量蛋白尿等门诊检测项目的开展率与检测时机；同时报告了针对CKD患者推荐的磷与甲状旁腺激素（parathyroid hormone, PTH）监测率。 结果：最终纳入10955例因AKI住院的患者，其出院时eGFR水平为2（原文此处可能存在录入疏漏）。在随访第90天和第365天的门诊随访中，分别有69%和85%的患者接受了肌酐检测，6%和12%的患者接受了定量蛋白尿检测，10%和15%的患者接受了PTH或磷检测。 结论：AKI患者出院后普遍接受肌酐检测，但即便合并基线肾脏疾病的AKI患者，也极少接受定量蛋白尿检测或矿物质代谢紊乱相关监测。