Patient Safety Alert - Acute Kidney Injury (AKI)

In recent years, our understanding of acute kidney injury has led to some laboratories designing their own calculated AKI alert for use in their laboratory information managements system (LIMS; the computer system that handles patient test results). The NHS England alert provides a standardised version of the algorithm to ensure the same practice is used across all NHS laboratories in England. 

The AKI warning algorithm was developed with the full co-operation of laboratory professionals and is strongly supported by the Association for Clinical Biochemistry and Laboratory Medicine, The Institute of Biomedical Science and the Royal College of Pathologists. The alerts will primarily be implemented in secondary and tertiary care settings but this will eventually extend to GP practices. The NHS England AKI programme will be supporting an extensive education programme for hospital and GP users of pathology services. 

Why the sudden interest in AKI? 

In 2009, a NCEPOD (National Confidential Enquiry into Patient Outcome and Death) report found that AKI detection and prevention was unacceptably low; if detected and treated early, the consequences of AKI (permanent renal damage) can largely be prevented. In response to this, clinical scientists and nephrologists joined forces to devise detection methods and alerting systems, based on changes in serum creatinine results, to notify clinicians to the presence of AKI and thus instigate measures to treat the condition. Alerts were stratified into stages 1, 2 or 3, with stage 3 being the most severe. Whilst these have proved to be successful in the main, the individual algorithms lacked harmonisation, thus a creatinine result may have triggered an AKI alert in one hospital, but not another. This standardisation will ensure that all healthcare providers use the same algorithm. 

How is this different from eGFR?

Estimated glomerular filtration rate eGFR is also a calculation based on the serum creatinine result but also uses the age and sex of the patient to provide a numerical value that indicates how well the kidneys are functioning. eGFR is used for the staging and monitoring of chronic kidney disease (CKD). 

For further information on the AKI alert, please follow this link.