Evaluating outcomes in critically ill patients with undiagnosed acute kidney injury: a comparison of the incidence of physician-diagnosed vs KDIGO criteria-diagnosed acute kidney injury.

Background: Acute kidney injury (AKI) independently predicts adverse outcomes, including morbidity, mortality, and prolonged hospital stays. Historically, inconsistent diagnostic criteria hindered the assessment of its prevalence. To address this, criteria such as Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) were developed. Applying these criteria remains challenging, especially in critical care settings, leading to underdiagnosis and poorer outcomes. Methods: This retrospective cohort study examined AKI incidence in critically ill patients by applying KDIGO criteria to charts of patients in the intensive care unit (ICU), comparing them to physician-diagnosed AKI. We examined the consequences for physician-undiagnosed AKI patients by analyzing variables such as mortality and hospital/ICU length of stay. Results: Of the 1063 patients meeting KDIGO AKI criteria, physicians diagnosed 486 cases, missing 54% of AKI cases identified by KDIGO criteria. AKI was associated with longer hospital and ICU stays and higher mortality. Early stage AKI was particularly prone to underdiagnosis. Discussion: This study reveals the underdiagnosis of AKI by ICU physicians. This significantly impacts patients with cardiovascular disease, complicating recovery from cardiac procedures and affecting both short-term and long-term outcomes. Enhancing early AKI surveillance offers an opportunity to optimize care and improve outcomes.