Excessive diagnostic testing in acute kidney injury

David E. Leaf*, Anand Srivastava, Xiaoxi Zeng, Gearoid M. McMahon, Heather E. Croy, Mallika L. Mendu, Allen Kachalia, Sushrut S. Waikar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish (US)
Article number224
JournalBMC Nephrology
Volume17
Issue number1
DOIs
StatePublished - Jan 15 2016

Keywords

  • Acute renal failure
  • AKI
  • Diagnostic yield

ASJC Scopus subject areas

  • Nephrology

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