45 - A Diluted Diagnosis of Acute Kidney Injury in the Medical Record of Extremely Low Birth Weight Infants?

Poster Number: 45
Publication Number: 45.2134

Background: Acute kidney injury (AKI) in extremely low birthweight (ELBW) infants is growing in recognition as an independent risk factor for short- and long-term morbidity and mortality. Nephrologists recommend enhanced follow-up screening for chronic kidney disease (CKD) and hypertension in neonates who experienced AKI. Despite the impact of AKI and its implication on recommended follow-up medical care, it was subjectively observed that few neonates were formally diagnosed with an AKI in our level 3 neonatal intensive care unit (NICU).

Objective: Our group sought to determine if there was a discrepancy in clinical AKI occurrence during NICU hospitalization and formal diagnosis in the electronic medical record (EMR).

Design/Methods: An IRB-approved retrospective chart review of infants born < 1,000 g was completed at an academic medical center. Demographic data and data on clinical AKI occurrence during the entire NICU hospitalization were collected. AKI was defined using the Kidney Disease: Improving Global Outcomes definition of rise in serum creatinine ≥ 0.3 mg/dL within 48 hours and gestational age (GA) specific creatinine cut-offs associated with increased mortality: creatinine level >1.6 mg/dL in infants up to 27 weeks, >1.1 mg/dL for 28-29 weeks, and >1.0 for 30-32 weeks. Search terms of “AKI”, “acute renal injury”, and “renal failure” were used within the EMR search tool, in medical problem lists, and in NICU discharge summaries to determine if AKI had been diagnosed by the medical team. Demographic data was analyzed using means, standard deviations, medians, interquartile range, minimums, and maximums for continuous data and counts and percentages for categorical data.

Results: Information on 47 ELBW neonates was collected. GA median was 26 (range 22.86-30.00). 55.3% (26/47) of these neonates had an AKI, but only 19.1% (9/47) of the population was formally diagnosed and documented in the EMR. Thus, despite a high clinical incidence of AKI, 65% of this population had no formal documentation of AKI occurrence.

Conclusion(s): Clinical AKI in ELBW neonates is significantly underdiagnosed in the EMR. This could lead to a lack of appropriate follow-up medical care and inappropriately decreased evaluation of hypertension and other chronic sequelae of AKI. Solutions to the underdiagnosis could be generating an EMR alert, creating an AKI review committee, and educating providers on the definitions and consequences of AKI. Future research is also needed to evaluate the health outcomes of infants who did not have formal medical documentation of AKI compared to infants with appropriate documentation.