Template:ICD10 Guideline KDIGO Guidelines for Acute Renal Failure

This template contains the KDIGO guideline definition so it can be applied consistently everywhere it is used.

To use:

{{ICD10 Guideline KDIGO Guidelines for Acute Renal Failure}}

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KDIGO Guidelines for Acute Kidney Injury (AKI)

• Starting January 1, 2019 when we began using ICD10 for diagnosis coding and CCI for procedure coding, we shifted to using the KDIGO criteria for defining Acute Kidney Injury -- which also goes by the names AKI, Acute Renal Failure and Acute Renal Insufficiency
• The main thing here is identifying that the observed problem with kidney function is acute, rather than chronic --- and THIS is the reason that identifying AKI requires trying to find a past/baseline value of serum creatinine
• These criteria will apply everywhere we need to identify ARF/AKI -- including Kidney, acute renal failure NOS and ARF (APACHE)
• In order to reduce the workload for identifying ARF/AKI, we will implement a first stage screening process to try and filter out the majority of people, who will NOT have AKI/ARF.
  • We expect that this screening WILL miss a few people, but we also expect that most of those who are missed will continue to experience declining renal function and their AKI/ARF will be identified in the following days.

CA Jones et al. Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 32(6):992-9, 1998 JY Tiao et al. The effect of age on serum creatinine levels in an aging population: relevance to vascular surgery. Cardiovasc Surg 10(5):445-51, 2002

First stage - screening

• Assume at admission that the patient does NOT have AKI/ARF if ALLof the following are true:
  • Creatinine <110 for males and <90 for females AND
  • No mention in chart of acute kidney/renal problems AND
  • No mention in the chart of oliguria
• The source used for these threshold values of serum creatinine are population-based surveys of serum creatinine in people without known kidney problems:
  • CA Jones et al. Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 32(6):992-9, 1998
  • JY Tiao et al. The effect of age on serum creatinine levels in an aging population: relevance to vascular surgery. Cardiovasc Surg 10(5):445-51, 2002

Second stage - Full assessment

• A patient has an Acute Kidney Injury (AKI) if any one or more of the following are true (these are the KDIGO guidelines):
  • Increase in serum creatinine by 27 micromoles/L or more within 48 hours
  • Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
    • baseline in this case means most recent from more than 7 days ago; e.g. if last is from 5 months ago use that.
    • if none available, use 88
  • Urine output less than 0.5 mL/kg/hour for 6 hours
    • if weight not available, use
      • ???also consider mention of obesity???
      • wait for the weight
      • ask ward nurses for weight
      • use details
        • 85kg for men
        • 70kg for women

for you to figure details; also, does this need to go into Kidney, acute renal failure, postprocedural Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic Kidney, acute tubular necrosis (ATN) Kidney, acute renal failure NOS ARF (APACHE)

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