Evaluation of Quality of Medical Care to Patients with the Risk of Developing Acute Kidney Injury

The purpose of the research: to analyze the quality of medical care of patients who are at risk of developing acute kidney injury.

Materials and methods. The work is based on a retrospective analysis of medical records of 140 patients with an acute kidney injury developed during their stay the intensive care units, surgical and medical units of district hospitals the Irkutsk Oblast over the period from 2012 to 2017.

Results. Inadequate assessment of the risk of an acute kidney injury was identified in 61% of patients. The most common inadequately assessed damaging factors were critical conditions (in 36% (50/140), sepsis (27% (38/140), and nephrotoxic drugs (19% (26/140). Among inadequately evaluated predisposing factors that could be managed, the following ones were most common: chronic heart disease (in 42% (59/140), dehydration/hypovolaemia (34% (47/140), chronic kidney disease (29% (41/140), and anemia (25% (35/140). In patients at risk of an acute kidney injury, an inadequate examination and inadequate maintenance therapy were found in 66% and 56% cases, respectively. Analysis of implementation of supporting therapy in patients at risk of an acute kidney injury the following misconducting events were revealed: (i) no optimal volumic and perfusion support (59% (82/140) and (ii) no cancellation of nephrotoxic and improperly prescribed drugs (31% (44/140).

Conclusions. A good quality medical care restricted only by 24% of patients at risk of an acute kidney injury developed in the ICU, surgical and medical departments of district hospitals of the Irkutsk Oblast. The development of an acute kidney injury when exposed to nephrotoxic drugs and dehydration/ hypovolemia in 14% of cases was predictable and preventable. 

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