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ARF (APACHE): Difference between revisions

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| field_name = Ap_ARF
| field_name = Ap_ARF
| CCMDB_label = ARF
| CCMDB_label = ARF
| CCMDB_tab = Apache
| element_description = The ARF checkbox is checked/true if patient is in Acute Renal Failure as per the APACHE definition.
| element_description = The ARF checkbox is checked/true if patient is in Acute Renal Failure as per the APACHE definition.
| in_table = L_Log table
| in_table = L_Log table
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| data_element_sort_index = 77
| data_element_sort_index = 77
}}
}}


== Additional Info ==
== Additional Info ==
*In original APACHE II there were no criteria given for what constitutes Acute Renal Failure.  So, we came up with criteria based on serum creatinine and urine output.  As we implemented ICD-10, we decided to use a uniform definition, i.e. the same one here as for the various ICD10 diagnoses of Acute Renal Failure -- i.e. the [http://kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf KDIGO guidelines].
Use the following uniform definition for ARF/AKI everywhere, including for APACHE II.
*(see historical info below as to criteria that was used for ARF)
 
== Coding {{g | Guideline}} ==
For critical care only:
The ARF ('''A'''cute '''R'''enal '''F'''ailure) dropdown for APACHE defaults to "enter"; you won't be able to send unless you change it to one of the following:
 
*'''Choose "yes"''' if any one or more of the following are true (these are the KDIGO guidelines)[http://kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf KDIGO guidelines]:
**Increase in serum creatinine by 26 micromoles/L or more within 48 hours
**Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
**Urine output less than 0.5 mL/kg/hour for 6 hours


'''Choose "no"''' if the pt
{{ICD10 Guideline KDIGO Guidelines for Acute Renal Failure}}
* has CRF in comorbids or
* does not meet the above "yes" conditions.


{{DiscussTask | coding rule details for ARF, see also [[Kidney, acute renal failure NOS]] }}
== Coding Guideline ==
{{Discuss | who = Allan | question =  
* For critical care only: The ARF ('''A'''cute '''R'''enal '''F'''ailure) dropdown for APACHE defaults to "enter"; you won't be able to send unless you change it to one of the following:
*The new coding guidelines for choosing “yes” in ARF for apache are based upon the KDIGO guidelines for defining acute kidney injury Stage 1. The stage 1 guideline would apply to the diagnosis of ARF in our diagnostic section, however, based upon my understanding of apache, it does not make sense in this scoring system.  My understanding of apache is that it is a predictor of hospital mortality, it is for severity of illness for critically ill patients. Where is the prognostic value if we put in every patient that qualifies as stage 1 AKI in the apache?  It would make our apache scores increase dramatically with this change as many patients have some kidney compromise in the ICU.   Perhaps we should be looking at stage 2 or 3 AKI for the apache score section.  Just wondering about this.  What do you think? - -See link for background of Apache II on wiki. --Nov 26, 2018 -Laura K
* '''Choose "no"''' if the pt
*AG REPLY --- to be discussed at next Task meeting}}
** does not meet the [[#KDIGO Guidelines for Acute Kidney Injury (AKI)]] '''or'''
** has a diagnosis of [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] (with or without dialysis)
*** Special Case- If a patient comes to ICU with a past history of [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] and had a kidney transplant during this admission.  As per Allan, unless the transplanted kidney was truly working postop (i.e. didn't need dialysis for at least a week or two) then do not code ARF.
* otherwise choose "yes"'''


== Data Use ==
== Data Use ==
ARF is one component used to generate the [[:Category:APACHE II| APACHE II]] score.
ARF is one component used to generate the [[:Category:APACHE II| APACHE II]] score.


Specifically, '''double points are assigned for the Creatinine score''' if the patient has ARF . (see [[APACHE Scoring table#Physiological Variables]])
Specifically, '''double points are assigned for the Creatinine score''' if the patient has ARF . (see [[APACHE_II_Background#Weighting_of_scores]] and  [[APACHE Scoring table#Physiological Variables]])


{{Data Integrity Check List}}
{{Data Integrity Check List}}


==See also ==
== Historical==
see [[:Category:Renal Problem (old)]] for other renal problems
*In original APACHE II there were no criteria given for what constitutes Acute Renal Failure.  So, from 1988 until 2018 we used a set of simple criteria based only on the admission serum creatinine and absolute urine output. But, when on January 1, 2019 we moved to ICD10 and CCI coding, we decided to use a
*there were criteria for ARF in the APACHE II user manual 1986, from George Washington University, Ver 1.0, that we applied when we started in 1988, they were:
**creatinine PLUS oliguria.  Oliguria was defined as: urine output of less than 135 cc over a consecutive 8 hr period in the first 24 hrs of ICU admission.
**Copy of this APACHE II User Manual can be found in the article archives library located in HSC JJ387.


== Related articles ==
== Related articles ==
{{Related Articles}}
{{Related Articles}}
== Historical==
*there were criteria for ARF in the APACHE II user manual 1986, Ver 1.0, that we applied when we started in 1988, they were: 
**creatinine PLUS oliguria.  Oliguria was defined as: urine output of less than 135 cc over a consecutive 8 hr period in the first 24 hrs of ICU admission.
**Copy of this APACHE II User Manual can be found in the article archives library located:  HSC in JJ387.


[[Category:APACHE II Physiological Variables]]
[[Category:APACHE II Physiological Variables]]
[[Category:Renal Problem (old)]]
[[Category:Renal Problem (old)]]
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