Excessive diagnostic testing in acute kidney injury.

Abstract:

BACKGROUND:The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. METHODS:We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. RESULTS:Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. CONCLUSIONS:In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility.

journal_name

BMC Nephrol

journal_title

BMC nephrology

authors

Leaf DE,Srivastava A,Zeng X,McMahon GM,Croy HE,Mendu ML,Kachalia A,Waikar SS

doi

10.1186/s12882-016-0224-8

subject

Has Abstract

pub_date

2016-01-15 00:00:00

pages

9

issn

1471-2369

pii

10.1186/s12882-016-0224-8

journal_volume

17

pub_type

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