Q&A: Querying for CKD stage without a baseline creatinine

Q: We recently had a patient come in with acute kidney injury (AKI). The patient had clinical indicators for chronic kidney disease (CKD), but their baseline creatinine was unknown. The patient has daily labs for 72 hours already, so would it be appropriate to query for the CKD stage even though the physician is documenting “unknown baseline?”

A: If the baseline creatinine is unknown, Kidney Disease Improving Quality Outcomes (KDIGO) recommends that the lowest creatinine level reached during hospitalization be considered “baseline” to determine if AKI has occurred using the “1.5 times baseline” criterion. KDIGO also allows the physician to presume that the increase may have occurred within seven days. Therefore, in this case, it would be appropriate to query the physician.

The KDIGO guidelines are available online for your review at www.kdigo.org.

Editor’s Note: Sharme Brodie, RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.