Difference between revisions of "ARF (APACHE)"

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** does not meet the [[#KDIGO Guidelines for Acute Kidney Injury (AKI)]]
 
** does not meet the [[#KDIGO Guidelines for Acute Kidney Injury (AKI)]]
 
*'''Choose "yes"''' if patient meets [[#KDIGO Guidelines for Acute Kidney Injury (AKI)]].  
 
*'''Choose "yes"''' if patient meets [[#KDIGO Guidelines for Acute Kidney Injury (AKI)]].  
{{Discuss|I have a patient with GFR 12, but not yet on HD at home. She came in septic, in AKI, which lead to a new start of HD during this admission. I entered CKD stage 5 in comorbs, AKI in admits, but it won't allow me to enter "YES" for ARF (APACHE), and "4CRF-sevr" under CHRONIC in APACHE. The definitions of chronic and acute renal failure are different for ICD10 and APACHE, so I am confused. What is the correct way of doing the APACHE for this patient? --[[User:Jvelasco|Jvelasco]] 10:34, 2020 May 21 (CDT)}}
+
{{DiscussTask |I have a patient with GFR 12, but not yet on HD at home. She came in septic, in AKI, which lead to a new start of HD during this admission. I entered CKD stage 5 in comorbs, AKI in admits, but '''it won't allow me to enter "YES" for ARF (APACHE),''' and "4CRF-sevr" under CHRONIC in APACHE. The definitions of chronic and acute renal failure are different for ICD10 and APACHE, so I am confused. What is the correct way of doing the APACHE for this patient? --[[User:Jvelasco|Jvelasco]] 10:34, 2020 May 21 (CDT)}}
  
 
== Data Use ==
 
== Data Use ==

Revision as of 11:08, 2020 May 22

Information on this page applies to the APACHE II ARF dropdown only; for the diagnosis code see any one of the several ICD10 codes for types/causes of ARF.

Data Element (edit)
Field Name: Ap_ARF
CCMDB Label: ARF
CCMDB tab: Apache
Table: L_Log table
Data type: number
Length: single
Program: CC
Created/Raw: Raw
Start Date: 1900-01-01
End Date: 2300-01-01
Sort Index: 77

The ARF checkbox is checked/true if patient is in Acute Renal Failure as per the APACHE definition.

Additional Info

Use the following uniform definition for ARF/AKI everywhere, including for APACHE II.

Terminology related to Acute Kidney Injury

  • Nephrologists want us to use the term Acute Kidney Injury (AKI).
    • The reason is that this entity, whatever it's called, includes the full range of levels of kidney injury from minor all the way up to complete renal shutdown needing dialysis.
  • Some other terms for it are:
    • Acute Renal Failure
    • Acute Renal Insufficiency (ARI)

KDIGO Guidelines for Acute Kidney Injury (AKI)

  • 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 misclassify a few people who do have AKI as not having it, 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

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; Do your best to estimate the weight, remembering that if the person appears to be of average size, then you could 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 met before 48 hrs, you cannot make a full determination that it is NOT true until you have at least 2 serum creatinine values separated by at least 48 hours
    • in the case that the creatinine rises by >27, say in the first 12 hours, but then declines back down so that at the end of 48 hrs the net rise is <27, THEN THIS DOES QUALIFY AS AKI
  • (c) Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
    • this criterion is important because since many people have some degree of CHRONIC renal insufficiency or failure, a solitary 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 -- use whatever is the most recent value more than 7 days old that is available, even if it's years old
    • if there ARE NO values >7 days old, then you can use the sex-specific normal value as follows:
      • Men: 100 micromoles/L
      • Women: 85 micromoles/L

Coding Guideline

For critical care only: The ARF (Acute Renal Failure) dropdown for APACHE defaults to "enter"; you won't be able to send unless you change it to one of the following:

Discuss@task.png

I have a patient with GFR 12, but not yet on HD at home. She came in septic, in AKI, which lead to a new start of HD during this admission. I entered CKD stage 5 in comorbs, AKI in admits, but it won't allow me to enter "YES" for ARF (APACHE), and "4CRF-sevr" under CHRONIC in APACHE. The definitions of chronic and acute renal failure are different for ICD10 and APACHE, so I am confused. What is the correct way of doing the APACHE for this patient? --Jvelasco 10:34, 2020 May 21 (CDT)

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Data Use

ARF is one component used to generate the APACHE II score.

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 Checks (SMW)

 AppStatus
Can't check ICD10 ARF vs APACHE ARFCCMDB.accdbdeclined
Query check ApARF CRFCCMDB.accdbretired
Query check ICD10 ESRD vs AP ARFnot enteredretired

Historical

  • 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

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