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Phil We use the AKI management programme provided by our LIMS (Telepath) for Real time AKI detection of inpatients We have used the rules based on the KDIGO guidelines Stage Serum creatinine (SCr) criteria Urine output criteria 1 increase ≥ 26 μmol/L within 48hrs or increase ≥1.5 to 1.9 X reference SCr <0.5 mL/kg/hr for > 6 consecutive hrs 2 increase ≥ 2 to 2.9 X reference SCr <0.5 mL/kg/ hr for > 12 hrs 3 increase ≥3 X reference SCr or <0.3 mL/kg/hr for increase to 354 μmol/L or >24hrs or anuria for commenced on renal replacement therapy 12hrs (RRT) irrespective of stage The reference serum creatinine should be the lowest creatinine value recorded within 3 months of the event If a reference serum creatinine value is not available within 3 months and AKI is suspected we suggest repeating creatinine within 24hrs For stage 1 only, we look for a reference creatinine within the last 7 days as recommended in the guidelines. The programme only allows for one time window for a reference creatinine i.e. 7 days or 90 days so you can't specify it to look further if no result is available in 7 days. The programme is able to identify the lowest creatinine in the last 90 days not just comparing the previous result. Hope this helps Richard Harris Principal Biochemist Kettering General Hospital -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Phillip Monaghan Sent: 21 March 2013 16:13 To: [log in to unmask] Subject: AKI detection --- This message was sent from an email address external to NHSmail but gives the appearance of being from an NHSmail (@nhs.net) address. The recipient should verify the sender and content before acting upon information contained within. The identified sender is [log in to unmask] --- Dear colleagues, We are currently liaising with our LIMS supplier (Technidata, TDLIMS) for real-time AKI detection. Has anyone had any good experience or advice on implementation of the rules based on the KDIGO guidelines that they would be willing to share? Additionally, with regard to AKI stage 1, I seek clarification on 1) the absolute increase stipulated in the guidance is 26.5umol/L, are labs therefore using 26 or 27? 2) When exactly is the 90 day reference interval for a baseline creatinine applicable? Is this just for AKI stages 2 and 3, or can we look at previous 90 days for AKI stage 1 (≥1.5 to 1.9x baseline) if there isn’t a creatinine result from within the previous 7 days. Furthermore, are LIS systems able to recognise the lowest (baseline) creatinine from within the previous 3 months, assuming that the previous creatinine result was not the baseline result? All help and guidance gratefully appreciated. Best wishes Phil ___________________________________ Dr Phillip J Monaghan BSc MSc PhD Principal Clinical Scientist Department of Clinical Biochemistry The Christie Hospital NHS Foundation Trust Wilmslow Road Withington Manchester M20 4BX ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ Kettering General Hospital NHS Foundation Trust, Rothwell Road, Kettering, Northants NN16 8UZ Tel: 01536 492000 This e-mail may contain confidential information and/or copyright material and is intended for the use of the addressee only. Any unauthorised use may be unlawful. The contents of this e-mail may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000. Unless legally exempt, the confidentiality of the message and your reply cannot be guaranteed. If you receive this e-mail by mistake, please advise the sender immediately. Scanning of this message and addition of this footer is performed by Sophos E-mail Filter software in conjunction with virus detection software. ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/