Excessive diagnostic testing in acute kidney injury

BMC Nephrology
David E LeafSushrut S Waikar

Abstract

The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. 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. 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-glomeru...Continue Reading

References

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Citations

Jun 30, 2019·BMJ : British Medical Journal·Indre K SemogasNicholas M P Annear
Jan 19, 2021·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Luke PickupCharles J Ferro
Jan 3, 2018·Seminars in Nephrology·Sushrut S Waikar, Gearoid M McMahon
May 28, 2021·Journal of Biomedical Informatics·Yang YangShengping Liu

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Methods Mentioned

BETA
biopsy
electrophoresis
biopsies

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