Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department

Abstract Background Acute kidney injury (AKI) incidence is increasing, however AKI is often missed at the emergency department (ED). AKI diagnosis depends on changes in kidney function by comparing a serum creatinine (SCr) measurement to a baseline value. However, it remains unclear to what extent d...

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Autores principales:	Michael Niemantsverdriet, Meriem Khairoun, Ayman El Idrissi, Romy Koopsen, Imo Hoefer, Wouter van Solinge, Jan Willem Uffen, Domenico Bellomo, Wouter Tiel Groenestege, Karin Kaasjager, Saskia Haitjema
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	AKI Creatinine CKD-EPI Electronic health records Digital health Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/65b6825179b04f25aa555412181b7324
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spelling	oai:doaj.org-article:65b6825179b04f25aa555412181b73242021-11-14T12:43:43ZAmbiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department10.1186/s12882-021-02581-x1471-2369https://doaj.org/article/65b6825179b04f25aa555412181b73242021-11-01T00:00:00Zhttps://doi.org/10.1186/s12882-021-02581-xhttps://doaj.org/toc/1471-2369Abstract Background Acute kidney injury (AKI) incidence is increasing, however AKI is often missed at the emergency department (ED). AKI diagnosis depends on changes in kidney function by comparing a serum creatinine (SCr) measurement to a baseline value. However, it remains unclear to what extent different baseline values may affect AKI diagnosis at ED. Methods Routine care data from ED visits between 2012 and 2019 were extracted from the Utrecht Patient Oriented Database. We evaluated baseline definitions with criteria from the RIFLE, AKIN and KDIGO guidelines. We evaluated four baseline SCr definitions (lowest, most recent, mean, median), as well as five different time windows (up to 365 days prior to ED visit) to select a baseline and compared this to the first measured SCr at ED. As an outcome, we assessed AKI prevalence at ED. Results We included 47,373 ED visits with both SCr-ED and SCr-BL available. Of these, 46,100 visits had a SCr-BL from the − 365/− 7 days time window. Apart from the lowest value, AKI prevalence remained similar for the other definitions when varying the time window. The lowest value with the − 365/− 7 time window resulted in the highest prevalence (21.4%). Importantly, applying the guidelines with all criteria resulted in major differences in prevalence ranging from 5.9 to 24.0%. Conclusions AKI prevalence varies with the use of different baseline definitions in ED patients. Clinicians, as well as researchers and developers of automatic diagnostic tools should take these considerations into account when aiming to diagnose AKI in clinical and research settings.Michael NiemantsverdrietMeriem KhairounAyman El IdrissiRomy KoopsenImo HoeferWouter van SolingeJan Willem UffenDomenico BellomoWouter Tiel GroenestegeKarin KaasjagerSaskia HaitjemaBMCarticleAKICreatinineCKD-EPIElectronic health recordsDigital healthDiseases of the genitourinary system. UrologyRC870-923ENBMC Nephrology, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	AKI Creatinine CKD-EPI Electronic health records Digital health Diseases of the genitourinary system. Urology RC870-923
spellingShingle	AKI Creatinine CKD-EPI Electronic health records Digital health Diseases of the genitourinary system. Urology RC870-923 Michael Niemantsverdriet Meriem Khairoun Ayman El Idrissi Romy Koopsen Imo Hoefer Wouter van Solinge Jan Willem Uffen Domenico Bellomo Wouter Tiel Groenestege Karin Kaasjager Saskia Haitjema Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
description	Abstract Background Acute kidney injury (AKI) incidence is increasing, however AKI is often missed at the emergency department (ED). AKI diagnosis depends on changes in kidney function by comparing a serum creatinine (SCr) measurement to a baseline value. However, it remains unclear to what extent different baseline values may affect AKI diagnosis at ED. Methods Routine care data from ED visits between 2012 and 2019 were extracted from the Utrecht Patient Oriented Database. We evaluated baseline definitions with criteria from the RIFLE, AKIN and KDIGO guidelines. We evaluated four baseline SCr definitions (lowest, most recent, mean, median), as well as five different time windows (up to 365 days prior to ED visit) to select a baseline and compared this to the first measured SCr at ED. As an outcome, we assessed AKI prevalence at ED. Results We included 47,373 ED visits with both SCr-ED and SCr-BL available. Of these, 46,100 visits had a SCr-BL from the − 365/− 7 days time window. Apart from the lowest value, AKI prevalence remained similar for the other definitions when varying the time window. The lowest value with the − 365/− 7 time window resulted in the highest prevalence (21.4%). Importantly, applying the guidelines with all criteria resulted in major differences in prevalence ranging from 5.9 to 24.0%. Conclusions AKI prevalence varies with the use of different baseline definitions in ED patients. Clinicians, as well as researchers and developers of automatic diagnostic tools should take these considerations into account when aiming to diagnose AKI in clinical and research settings.
format	article
author	Michael Niemantsverdriet Meriem Khairoun Ayman El Idrissi Romy Koopsen Imo Hoefer Wouter van Solinge Jan Willem Uffen Domenico Bellomo Wouter Tiel Groenestege Karin Kaasjager Saskia Haitjema
author_facet	Michael Niemantsverdriet Meriem Khairoun Ayman El Idrissi Romy Koopsen Imo Hoefer Wouter van Solinge Jan Willem Uffen Domenico Bellomo Wouter Tiel Groenestege Karin Kaasjager Saskia Haitjema
author_sort	Michael Niemantsverdriet
title	Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
title_short	Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
title_full	Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
title_fullStr	Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
title_full_unstemmed	Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
title_sort	ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department
publisher	BMC
publishDate	2021
url	https://doaj.org/article/65b6825179b04f25aa555412181b7324
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Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department

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