Reducing the Incidence of Acute Kidney Injury

Reducing the Incidence of Acute Kidney Injury

Charles Brooks, MD, MSc

Reducing the Incidence of Acute Kidney Injury

Charles Brooks

Charles Brooks, MD, MSc

Acute kidney injury (AKI), an independent risk factor for the development of chronic kidney disease, end-stage renal disease, and death, is a known complication of invasive procedures used in the diagnosis and treatment of cardiovascular disease. In addition to increased morbidity and mortality, AKI results in substantial increases to hospital costs.

Serum creatinine is a byproduct of muscle metabolism and an important measure of renal health. Even small increases in serum creatinine following cardiac surgery are associated with adverse outcomes; a single episode of AKI that results in a tripling of serum creatinine levels increases hospital costs by an average of $74,178. No drugs are currently approved for treatment of AKI, which has led us to ask: what are alternative methods for reducing the incidence of AKI? This clinical question propelled a multidisciplinary effort in the Division of Nephrology: the Acute Kidney Injury Risk Reduction Initiative.

We are investigating process and exposure variables for pre-, intra- and post-operative procedures, and designing risk-reduction interventions. The initiative’s preliminary outcomes data for cardiac surgery for the first three quarters since implementation of these interventions has shown a decrease in risk-adjusted incidence of AKI of one-third compared to baseline, with cost savings exceeding several hundred thousand dollars. We are continuing to develop and implement AKI risk-reduction strategies in each of the surgical service disciplines.

Acute Kidney Risk chart