Developing a consensus for AKI definition for database research: findings from a scoping review and expert opinion using a Delphi Process

Greg Guthrie, Bruce Guthrie, Heather Walker, Matthew T James, Nicholas M Selby, Marcello Tonelli, Samira Bell

Research output: Contribution to journalArticlepeer-review

Abstract

Rationale & ObjectiveThe Kidney Disease Improving Global Outcomes (KDIGO) definition of Acute Kidney Injury (AKI) is frequently used in studies to examine the epidemiology of AKI. This definition is open to variations in interpretation and application to routinely collected healthcare data. The aim of this study was to examine variation in how the KDIGO definition is used to define AKI and to achieve consensus in how AKI should be defined for research using routinely collected healthcare data.Study DesignA scoping review was performed searching MEDLINE and EMBASE for studies examining AKI utilising the KDIGO creatinine-based definition in healthcare data. An international panel was formed to participate in a modified Delphi process to attempt to generate consensus about how AKI should be defined when using routinely collected laboratory data.ResultsThe scoping review found 174 studies which met the inclusion criteria. The KDIGO definition was inconsistently applied and the methods for application were poorly described. 58 (33.3%) of papers did not provide a definition of how the baseline creatinine value was determined. 35 respondents participated in round 1 and 25 participated in round 2 of the Delphi process. Some consensus was achieved in areas relating to defining baseline creatinine, which patients should 3 be excluded from analysis of routinely collected laboratory data and how persistent chronic kidney disease or non-recovery of AKI should be defined.LimitationsThe Delphi panel predominantly came from the UK, USA and Canada with low response rates for some questions in round one.ConclusionThe methods used to define AKI using routinely collected data are inconsistent and poorly described in the available literature. It was not possible to achieve consensus for many of the aspects pertaining to AKI definition and description of AKI sequelae. The KDIGO guidelines should be extended to include a standardised definition for how AKI should be defined when using routinely collected data.Index WordsAcute Kidney Injury; AKI; KDIGO definition; data
Original languageEnglish
JournalAmerican Journal of Kidney Diseases
DOIs
Publication statusPublished - 20 Jul 2021

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