Ensuring Optimal Patient Outcomes: The Critical Role of Accurate Documentation for Acute Kidney Injury and Renal Failure
Written By: Samy Allam MD, MHA
Did you know that acute kidney injury and renal failure are severe health conditions that affect millions of people globally? These conditions can appear in various ways and can result in significant health problems if left untreated. Especially in the setting of Heart Failure or Hypertension. Therefore, it's vital to be aware of the different conditions under the umbrella of acute kidney disease and at-risk populations (See Figure 1). This knowledge is crucial for Quality, value-based treatment, Mortality Indices, and Clinical Documentation Integrity (CDI). More accurate diagnoses can lead to better patient outcomes and impact treatment plans.?
Renal Failure is a condition where the kidneys lose their function to such an extent that dialysis or renal replacement therapy is required to sustain life. Dialysis usually marks End end-stage renal Disease, where the kidney function has declined to the point of complete or near-complete cessation. Immediate and intensive medical intervention is necessary to prevent complications and restore renal function, if possible, in cases of acute kidney injury. But what about exacerbation of chronic kidney conditions, where patients may present with acute on top of chronic kidney failure?
The documentation of value-based treatment highlights the importance of providing high-quality care that leads to the best possible results while minimizing costs and hospital resource waste. In the case of acute kidney injury (AKI) and kidney failure, this means identifying the condition early on, making an accurate diagnosis, and implementing appropriate management strategies that are tailored to the specific needs of each patient in the acute care setting.
It can be challenging to accurately document value-based treatment because acute kidney injury (AKI) and kidney failure can have similar clinical presentations. However, advancements in diagnostic techniques such as biomarker testing and imaging studies have improved our ability to identify and classify renal dysfunction. Your hospital's Clinical Documentation Integrity (CDI) program can assess the risk and optimize outcomes of patients' reported data. To achieve this goal, the following three criteria are commonly used:
What are the Appropriate Criteria and Methods for Effective CDI Queries?
This can be a detailed conversation on hospital metrics and core measures. However, let's discuss the advantages and disadvantages of each criterion to understand better which criteria suit your organization best. Please see Figure 2
The AKIN vs RIFLE Criteria
The AKIN criteria were developed by a collaboration of nephrologists and intensivists to improve the sensitivity and reliability of the RIFLE criteria. Evidence suggests that even small changes in serum creatinine can increase mortality rates. The AKIN criteria introduced a new definition by considering these minor changes in serum creatinine values within 48 hours without first comparing them with a baseline value. The need for renal replacement therapy (RRT) was also considered.
领英推荐
One significant advantage of the AKIN criteria is that it does not use the individual's baseline creatinine. To compare the values of this biomarker under AKIN, two measurements are required: an initial measurement (which corresponds to the baseline used by RIFLE) and another obtained after 48 hours. Patients with a primary alteration in serum creatinine >0.3mg/dL or an increase ≥150-199% over the first measurement are classified as having stage 1 injury (corresponding to the Risk stage of RIFLE). When the rise in serum creatinine is 200-299% compared with the first measurement, the patient is classified as stage 2 (corresponding to the RIFLE injury stage). Finally, patients with ≥300% increase over the initial creatinine or a serum creatinine ≥4.0mg/dL with an abrupt rise of at least 0.5mg/dL or the onset of TSR (Tubulointerstitial Fibrosis and Tubular atrophy) are grouped (corresponding to the Failure stage of RIFLE).?
Why KDIGO?
The classification proposed by RIFLE had two significant shortcomings. The first was that it depended directly on obtaining the baseline creatinine for each patient, which did not necessarily reflect the state of renal involvement. Secondly, no specific stage was defined for patients who required RRT. The modifications adopted to generate AKIN were relevant.
More recently, the Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group proposed changes to the staging for AKI. This new classification was important and novel for medical practice, especially concerning the time criterion. KDIGO covers both the AKIN?and RIFLE criteria, taking into account changes in creatinine within 48 hours or a decline in the glomerular filtration rate (GFR) over seven days. Moreover, patients under 18 with a GFR <35mL/min and patients with a serum creatinine >4.0mg/dL (absolute value) were added to AKIN stage 3.?
After the Diagnosis of Acute Kidney Injury or Failure
After being diagnosed with acute kidney injury or failure, the priority is to implement interventions based on available evidence of Severity of Illness (SOI) or Risk of Mortality (ROM) to prevent further damage to the kidneys and promote recovery. This may involve managing fluid balance, addressing underlying medical conditions, and avoiding using medications or contrasts that can harm the kidneys further. In severe cases, renal replacement therapy such as hemodialysis or continuous renal replacement therapy may be necessary to support the kidneys while allowing time for recovery. To ensure compliance with the ACDIS/AHIMA query brief, you can choose the core measure selected by your hospital for your clinical queries.
Pertaining to your facility guidance; you can prioritize interdisciplinary collaboration in managing acute kidney injury (AKI) and kidney failure, according to value-based treatment strategies. A team of nephrologists, intensivists, pharmacists, nurses, and others should collaborate to monitor patients' progress, coordinate care, and adjust treatment strategies when necessary. When performing Clinical Documentation Integrity (CDI) reviews, paying close attention to all these notes is crucial. A collaborative approach ensures patients receive personalized and comprehensive care, leading to better outcomes and reduced healthcare costs. Your CDI query's primary objective should be optimizing care and minimizing resource loss.
Conclusion?
Furthermore, long-term follow-up and management are essential for value-based treatment integrity to extend beyond the acute phase of AKI and kidney failure. Patients who survive an episode of AKI or kidney failure are at increased risk. Hence, your outpatient CDI program can play a crucial role in maintaining the quality of information over time and at scale.
As we wrap up, let us remember the importance of distinguishing between AKI and kidney failure in delivering high-quality care to those with renal dysfunction. By adopting precise diagnostic criteria, evidence-based interventions, interdisciplinary collaboration, and long-term data capture and follow-up, we can ensure that our healthcare system prioritizes value and excellence in managing AKI and renal diseases. Let us stay tuned for the next discussion on the population at risk of developing AKI and continue striving to deliver care that maximizes outcomes, minimizes costs, and improves patients' quality of life.
If you want to enhance your CDI department, please schedule a consultation call today to see how DextroMedical can unlock your healthcare facility's potential.
Make sure you take advantage of the latest CDI insights by subscribing to our newsletter today. Subscribe now to stay ahead in the industry!