Incidence, Recognition, and Follow-up of Laboratory Evidence of Acute Kidney Injury in Primary Care Practices: Analysis of 93,259 Creatinine Results

Authors

Jose Mena, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Marc Rodriguez, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Scot B. Sternberg, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Timothy Graham, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Leonor Fernandez, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
James Benneyan, Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts.
Talya Salant, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Bowdoin Street Health Center, Boston, MA.
Amie Pollack, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Dru Ricci, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Russell S. Phillips, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Center for Primary Care, Boston, Massachusetts.
Umber Shafiq, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Mark D. Aronson, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Gordon D. Schiff, Harvard Medical School, Center for Primary Care, Boston, Massachusetts; Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts.
Bradley M. Denker, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: bdenker@bidmc.harvard.edu.

Document Type

Journal Article

Publication Date

9-4-2024

Journal

The American journal of medicine

DOI

10.1016/j.amjmed.2024.08.032

Keywords

acute kidney injury; chronic kidney disease; creatinine; glomerular filtration rate; primary care

Abstract

BACKGROUND: Community acquired acute kidney injury (CA-acute kidney injury) is under-recognized in the outpatient setting and is associated with adverse outcomes. METHODS: We analyzed the incidence of CA-acute kidney injury in an academic primary care practice and community health center and assessed recognition/followup as determined by repeat creatinine measurement (loop-closed). We reviewed 93,259 specimens for 36,593 unique patients from 1/1/2018 through 12/31/2021. RESULTS: There were 220 unique patients with CA-acute kidney injury defined as a >75% increase in creatinine from baseline; incidence: 150/100,000 (0.15% per year). 137 patients (62.3%) had repeat serum creatinine performed within 30 days. Chart reviews of the 83 (37.72%) patients with open loops found there was no follow-up creatinine ordered in 69/83 (83.1%) patients. Mean baseline creatinine was higher and eGFR was lower in the loop-closed group (0.92±0.4mg/dl; 84.45±27.49mls/min) versus (0.63±0.34mg/dl; 105.19±26.67mls/min) in the loop-open group (p<.0001). Preexisting chronic kidney disease was more prevalent in loop-closed patients (35/137; 25.6%) compared to those with open-loops (3/83; 3.6%). Patients with baseline chronic kidney disease were more likely to have the loop-closed. Progression to new chronic kidney disease was common among CA-acute kidney injury patients, occurring in 23.94% of loop-open and 17.50% of loop-closed patients. New baseline eGFR was lower in all groups. CONCLUSIONS: Clinicians frequently overlooked a clinically significant change in eGFR, especially when the baseline creatinine and incident creatinine levels were in the "normal" range.

APA Citation

Mena, Jose; Rodriguez, Marc; Sternberg, Scot B.; Graham, Timothy; Fernandez, Leonor; Benneyan, James; Salant, Talya; Pollack, Amie; Ricci, Dru; Phillips, Russell S.; Shafiq, Umber; Aronson, Mark D.; Schiff, Gordon D.; and Denker, Bradley M., "Incidence, Recognition, and Follow-up of Laboratory Evidence of Acute Kidney Injury in Primary Care Practices: Analysis of 93,259 Creatinine Results" (2024). GW Authored Works. Paper 5683.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5683

Department

Pathology