Hi Gary,



I am not sure that the 48hr value is the primary trigger. In any patient the serum creatinine could rise by >28 umol/l within 48 hours but by > 2.0 X  reference value if one looks back 7 days. The algorithm reports the highest AKI stage which I think is correct.



Kind regards



Mike



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-----Original Message-----

From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of Gary Mascall

Sent: 13 July 2015 11:15

To: [log in to unmask]

Subject: Query over 48 hour rule



I would like someone to look at the following scenario to decide which is the correct AKI warning alert for a patient:



Most recent Creatinine 254 umol/L.

Previous creatinine 47 hours 49 minutes previously 136 umol/L.

Lowest creatinine within last 7 days 116 umol/L.



So, looking at the National algorithm, this looks for the lowest value in last 7 days, and using this value of 116umol/L, finds the ratio is >2, so it will be AKI warning alert 2.



BUT, if you look at the original wording of the Renal Association document, it states:

Acute kidney injury is defined when one of the following criteria is met · Serum creatinine rises by ≥ 26μmol/L within 48 hours or · Serum creatinine rises ≥ 1.5 fold from the reference value, which is known or presumed to have occurred within one week



So there is a subtle, but noticeable difference, here the 48 hour value is the primary trigger, and using this interpretation the AKI warning alert would be 1.



Some advice /assistance would be welcome, because it appears the National algorithm has slightly changed the order in which things are calculated, which can give rise to a different interpretation.



Many Thanks,

Gary Mascall

Worcestershire Acute Hospitals NHS Trust.



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