Abstract

CAMPOS GUTIERREZ, B.  and  GRUPO DE INVESTIGACION ERC ARAGON et al. Undiagnosed kidney disease in hospitalised patients: an opportunity for improvement. Nefrología (Madr.) [online]. 2011, vol.31, n.1, pp.70-75. ISSN 1989-2284.

Objectives: In hospitalized patients, chronic kidney disease (CKD) and acute kidney failure (AKI) are associated with morbidity, mortality and drug toxicity. We identify improvement care opportunities in patients with renal disease in a hospital without intensive care unit. Material and method: Patients: 200 hospitalized patients in Alcañiz Hospital (Spain) in the second half of 2008 were randomly selected. Data sources: laboratory data, clinical history and discharge report. RLIPT criteria were applied to define acute kidney failure (AKI). Quality indicators: 1) percentage of hospitalized patients with renal function control (at least one determination of renal function during admission). 2) percentage of patients with CKD and/or AKI with this diagnosis recorded in clinical course. 3) percentage of patients with ERC and/or AKI with this diagnosis recorded in discharge report. Results: Mean age was 71.1 ± 17 years, 42% women, 63% admitted to medical areas and 37% to surgical areas. 194 patients have renal function control at admission, however during admission renal function was not monitorized in 54 patients (27%), especially in surgical areas. Previous ERC was detected in 50 patients (25%), although this diagnosis figure only in the clinical course in 14 (28%), and in the discharge report in 17 (34%). AKI is detected in 68 of the 146 patients with renal function control during hospitalization (46.5%). This information is contained in the clinical course in only 50% and in the discharge report in 33,8%. Conclusions: CKD at admission and AKI during hospitalization are frequent. Often these diagnoses are not included in clinical course or in discharge report, reflecting a poor process awareness. A clinical protocol implementation and diffusion could be important in order to achieve a more efficient and consistent management of these processes in hospitalized patients.

Keywords : Chronic kidney disease; Acute kidney failure; Hospitalary kidney disease; Kidney disease in hospitalized patients; Early detection of kidney disease.

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