Adventist Health System
Office of Clinical Effectiveness
Hospital Harm – Acute Kidney Injury (AKI)

We do not support the usefulness of this electronic measure in identifying instances of AKI that develop during hospitalization. Acute kidney injury is not solely determined by a creatinine level baseline increase. Determining if an acute kidney injury harm has occurred requires clinical verification and/or a review of the patient record for evidence of contributing medication administration and patient treatment course. This measure has low specificity for AKI harms that develop during hospitalization. If the development of this measure continues, we recommend the following changes to increase the measure value:
For baseline creatinine, consider decreasing rolling window timeframe from previous 7 days to previous 3 days:
1) to better align with the Acute Kidney Injury Network (AKIN) definition
2) to prevent capturing an elevated creatinine that occurred prior to admission
3) to establish a more timely and accurate baseline

Consider decreasing the denominator to only include patients with a creatinine level of 1.0 or greater
1) Creatinine levels below 1.0 most likely do not reflect an increase consistent with acute kidney injury even in the presence of administered nephrotoxins. Doing so will decrease the incidences of capturing false positive AKI harms.