Sandra L Kane-Gill1, Sadudee Peerapornratana2, Adrian Wong3, Raghavan Murugan4, Lara M Groetzinger5, Catherine Kim5, Pamela L Smithburger5, Janine Then5, John A Kellum4. 1. University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, United States of America; UPMC, Department of Pharmacy, Pittsburgh, PA, United States of America; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America. Electronic address: slk54@pitt.edu. 2. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America; Excellence Center for Critical Care Nephrology, Division of Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 3. MCPHS University, Department of Pharmacy Practice, Boston, MA, United States of America. 4. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America. 5. UPMC, Department of Pharmacy, Pittsburgh, PA, United States of America.
Abstract
PURPOSE: To determine the application of various components of the Kidney Disease Improving Global Outcomes (KDIGO) bundle in managing patients at high-risk for AKI progression ([TIMP2]•[IGFBP7] >0.3) in the real-world setting. METHODS: Patients with a [TIMP2]•[IGFBP7] test ordered between 5/23/16-2/28/18 were evaluated. We reviewed the medical record for evidence of implementation of the KDIGO bundle in response to biomarker test results. Evidence including explicit documentation in physicians' note discussing [TIMP2]•[IGFBP7] results and implicit evidence from review of dose adjusted medications, discontinued nephrotoxins and therapeutic drug monitoring. RESULTS: 105 [TIMP2]•[IGFBP7] tests were conducted in 100 patients (54% female; mean age 55.4 ± 16.8; 89% in the ICU). Sixty-one patients had a value of >0.3 and 46 (75.4%) of these patients received at least one management strategy consistent with KDIGO. By contrast, nine patients (23.1%) with [TIMP2]•[IGFBP7] ≤0.3 received one or more components of the KDIGO bundle (p < .001). CONCLUSION: In a real-world setting the use of urinary [TIMP2]•[IGFBP7] as an AKI risk screening tool resulted in differential application of various components of the KDIGO bundle for patient management for those with a positive test result.
PURPOSE: To determine the application of various components of the Kidney Disease Improving Global Outcomes (KDIGO) bundle in managing patients at high-risk for AKI progression ([TIMP2]•[IGFBP7] >0.3) in the real-world setting. METHODS:Patients with a [TIMP2]•[IGFBP7] test ordered between 5/23/16-2/28/18 were evaluated. We reviewed the medical record for evidence of implementation of the KDIGO bundle in response to biomarker test results. Evidence including explicit documentation in physicians' note discussing [TIMP2]•[IGFBP7] results and implicit evidence from review of dose adjusted medications, discontinued nephrotoxins and therapeutic drug monitoring. RESULTS: 105 [TIMP2]•[IGFBP7] tests were conducted in 100 patients (54% female; mean age 55.4 ± 16.8; 89% in the ICU). Sixty-one patients had a value of >0.3 and 46 (75.4%) of these patients received at least one management strategy consistent with KDIGO. By contrast, nine patients (23.1%) with [TIMP2]•[IGFBP7] ≤0.3 received one or more components of the KDIGO bundle (p < .001). CONCLUSION: In a real-world setting the use of urinary [TIMP2]•[IGFBP7] as an AKI risk screening tool resulted in differential application of various components of the KDIGO bundle for patient management for those with a positive test result.
Authors: Luca Molinari; Fabienne Heskia; Sadudee Peerapornratana; Claudio Ronco; Louis Guzzi; Seth Toback; Robert Birch; Hadi Beyhaghi; Thomas Kwan; J Patrick Kampf; Donald M Yealy; John A Kellum Journal: Crit Care Med Date: 2021-10-01 Impact factor: 9.296