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:

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.

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

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
(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:

M F

<45 101 81 45-54 101 84 55-64 101 84 65-74 101 87 75-84 106 91 85+ 108 93

- - 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

	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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