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.

First stage - screening

• Assume at admission that the patient does NOT have AKI/ARF if ALLof the following are true:
  • (1) Creatinine <110 for males and <90 for females AND
  • (2) No mention in chart of acute kidney/renal problems AND
  • (3) 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
• If ANY of 1, 2 or 3 are false, then go on to the full evaluation in the Second Stage

Second stage - Full assessment

• Acute Kidney Injury (AKI) is present if ANY ONE OR MORE of the following are true (these are the KDIGO guidelines):
• (a) Urine output < 0.5 mL/kg/hour for 6 hours
  • so, obviously, you can't make this determination until there has been at least 6 hours of observation of urine output
  • also you need a weight -- if there isn't one already measured you have the following options: Wait for one to be done; Ask the nurse to do one; Use default values based on average values in the Canadian population, i.e. 85 kg for men and 70 kg for women
• (b) Increase in serum creatinine by 27 micromoles/L or more within 48 hours
  • so, while this may happen quickly and thus this criterion be true, you cannot make the determination that this is NOT true until you have at least 2 serum creatinine values separated by at least 48 hours (sorry)
• (c) Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
  • this criterion is important because so many people have some degree of CHRONIC renal insufficiency or failure that a single serum creatinine can't tell you if the high value is acute or chronic
  • thus, to evaluate this criterion, seek a serum creatinine value at least 7 days old -- if the most recent value you can find is years ago, USE THAT
  • if and only if you cannot find any values >7 days old, then you can use the age-specific normal value as follows:
    • MEN: 100 micromoles/L
    • Women: 85 micromoles/L

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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