Can you clarify the AKI definition?
There are a lot of components to the AKI definition.
For patients < (less than) 18 years, a decrease in eGFR to < 35 (less than 35) ml/min per 1.73 m², would meet the AKI definition.
A patient with an increase in SCr to > 4.0 mg/dl (greater than or equal to 4.0) would meet the AKI definition.
In order to capture AKI (stage 3), an abrupt decrease in kidney function (see table) must have occurred during the patient’s stay at your hospital. The only exclusion in the definition is for patients with renal failure that were requiring chronic renal replacement therapy such as periodic peritoneal dialysis, hemodialysis, hemofiltration, or hemodiafiltration prior to injury.
PTOS follows the NTDB/TQIP definition for AKI which is also consistent with KDIGO.
There was an error previously. This correction was made mid-year in 2018 and is now correct in the PTOS manual. This was discussed in detail at registry committee throughout 2018. It took some time to consult with the NTDB and KDIGO before the correction was made. This was an error in the NTDB’s definition that we utilized. They made the correction without notice. It took about a year for the correction to take place in PTOS. Please note that this could account for high incidence of AKI in TQIP reports. The issue should now be resolved for future reports.
Acute Kidney Injury:
(Consistent with the March 2012 Kidney Disease Improving Global Outcome
(KDIGO) Guideline.) Acute Kidney Injury, AKI (stage 3), is an abrupt decrease in kidney function that
occurred during the patient’s initial stay at your hospital.
KDIGO (Stage 3) Table:
(SCr) 3 times baseline
Increase in SCr to > 4.0 mg/dl (> 353.6 umol/l)
Initiation of renal replacement therapy OR, In patients < 18 years, decrease in eGFR to <35
ml/min per 1.73 m²
Urine output <0.3 ml/kg/h for > 24 hours
Anuria for > 12 hours
A diagnosis of AKI must be documented in the patient’s medical record. If the patient or family refuses
treatment (e.g., dialysis,) the condition is still considered to be present if a combination of oliguria and
creatinine are present.
EXCLUDE patients with renal failure that were requiring chronic renal replacement therapy such as
periodic peritoneal dialysis, hemodialysis, hemofiltration, or hemodiafiltration prior to injury.