A-035 The role of Nephrocheck in the early detection and prevention of cardiac surgery related AKI in ICU patients at a tertiary hospital over 8 months

Abstract Background Acute Kidney Injury is a frequent perioperative complication in cardiac surgery patients. The routine implementation of Nephrocheck by our Cardiothoracic Surgery Team was aimed to assist in the early detection of patients at high risk of developing AKI after surgery, with the deployment of AKI prevention bundles and close monitoring at ICU for those at high risk. Methods Nephrocheck testing was performed on all cardiac open-heart procedures (excluding ESRD, VAD, TXP). Samples were collected from 6-8 hours after cardiac surgery and the AKI Risk Score determined. AKI high risk score patients (>0.3 (ng/ml)2/1000) indicating kidney stress were compared vs patients with low AKI risk score (score (<0.3 (ng/ml)2/1000) for the development of acute kidney injury according to the KDIGO definition of AKI. Results At the single cutoff of AKIRISK score of 0.30 established by the vendor we observed a low discrimination power. Many patients with AKIRISK > 0.30 were classified at increased risk of developing AKI in the next 12 hours of assessment but evolved with normal postoperative course. Statistical analysis with a new AKIRISK score of 1.00 suggested a better correlation with development of AKI in the next 12 hours of assessment according to traditional methods of monitoring kidney function like serum creatinine and urine output. Conclusion Based on clinical performance the CTS Team decided to discontinue the use of Nephrocheck. The Nephrocheck test is indicated for use in patients who are critically ill. In our tertiary hospital, all the patients in the ICU are already receiving all the necessary interventions designed to prevent acute kidney injury. The potential of this test in our cardiac surgery cohort was of limited use as the test result did not change management decisions.