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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Nephrology 1/2016

Excessive diagnostic testing in acute kidney injury

Zeitschrift:
BMC Nephrology > Ausgabe 1/2016
Autoren:
David E. Leaf, Anand Srivastava, Xiaoxi Zeng, Gearoid M. McMahon, Heather E. Croy, Mallika L. Mendu, Allen Kachalia, Sushrut S. Waikar
Wichtige Hinweise

Competing interests

The authors declare no conflicts of interest.

Authors’ contributions

DEL and SSW designed the research and wrote the manuscript. AS, XZ, GMM, HEC, MLM, and AK provided assistance with chart review and critically revising the manuscript. All authors approve the final version of the manuscript, and agree to be accountable for all aspects of the work.

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.
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