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.