Related Experiment Video
Updated: Jun 4, 2026
09:02
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Concordance Analysis Between KDIGO Definition of Acute Kidney Injury and Its Coding in Clinical Practice
Ashis Kumar Chanda1, Elmira Talebianaraki1, Vahid Mahzoon1
1Department of Computer and Information Sciences, Temple University, Philadelphia, PA.
Kidney Medicine
|June 3, 2026
Summary
Acute kidney injury (AKI) research criteria show low agreement with clinical ICD codes. A formula using maximum serum creatinine levels better aligns with clinical documentation for AKI identification.
Area of Science:
- Nephrology
- Clinical Informatics
- Health Services Research
Background:
- Acute kidney injury (AKI) diagnosis differs between research (KDIGO criteria) and clinical practice (ICD codes).
- Understanding the concordance between these methods is crucial for accurate patient care and research.
- Previous studies have not fully explored the discrepancies and their implications.
Purpose of the Study:
- To evaluate the concordance between KDIGO criteria-defined AKI and clinically documented AKI using ICD codes.
- To analyze discordant cases to identify the strengths and weaknesses of each AKI identification method.
- To explore alternative methods for AKI detection that may improve clinical documentation.
Main Methods:
- Retrospective cohort study of 54,210 hospital admissions from Beth Israel Deaconess Medical Center (2008-2022).
- Analysis of serum creatinine (SCr) levels and urine output volumes.
- Quantification of concordance using Cohen's kappa (κ) and machine learning models to assess SCr association with coded AKI.
Main Results:
- Low concordance (κ = 0.37) was observed between KDIGO criteria-defined AKI and ICD-coded AKI.
- A formula using maximum SCr levels showed higher concordance (κ = 0.61).
- KDIGO criteria identified minor SCr increases missed by coding, while coding captured high initial SCr levels missed by KDIGO.
Conclusions:
- Significant discrepancies exist between research-based KDIGO criteria and clinical ICD coding for AKI.
- Maximum SCr level formula offers improved concordance with clinical AKI documentation.
- Further research is needed to refine AKI identification methods in clinical practice.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
01:20Acute Kidney Injury V: Interprofessional Care
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
01:29Acute Kidney Injury III: Clinical Manifestations
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
01:29Acute Kidney Injury II: Pathophysiology
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
01:22Acute Kidney Injury VI: Nursing Management
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...