ABSTRACT
Introduction: Early detection and management of community acquired Acute Kidney Injury (AKI) can reduce associated morbidity and mortality particularly in low and low middle-income countries where infrastructure for laboratory tests is limited and renal replacement therapy is largely unavailable. We have established a collaborative project between the Renal Unit of the University of Port Harcourt Teaching Hospital and the Renal Department of Salford Royal NHS Foundation Trust, supported by the International Society of Nephrology aiming at investigating the use of point of care (POC) Creatinine (Cr) for early identification and management of community acquired AKI. The first part of the study evaluated the accuracy of POC Cr technology by comparison with the central laboratory standard Cr assay used at the University of Port Harcourt Teaching Hospital and showed good overall correlation with mean bias of 27.2 umol/L concluding that POC Cr > 150 umol/L reflects AKI in the absence of known chronic kidney disease (CKD). Here we present the second part of the study investigating the use of POC Cr in the Emergency Department (ED) and the third part, that was formulated with the emergence of the COVID-19 pandemic, assessing the POC Cr technology in the COVID-19 isolation centres. Methods: The second part of this study was conducted at the ED of University of Port Harcourt Teaching Hospital (UPTH) between January and December 2020. Adult patients were screened by Nephrology residents with POC Cr using a capillary sample (fingerstick) with the NOVA Stasensor Xpress Cr analyser if there was clinical suspicion of community acquired AKI. The third part of this study was that of the use of POC Cr as screening tool to evaluate AKI in COVID-19 patients at 2 COVID-19 isolation centres in Rivers state. Data were extracted from the case notes of the patients and a proforma designed for the study. Results: In the second stage, between January and December 2020, 53 patients aged 48±19 with clinical suspicion of community acquired AKI were screened with POC Cr in the ED;45.3% were females, 5.7% had known chronic kidney disease and 75.5% had suspected infection and/or hypovolaemia. 21 out of 53 patients (39.6%) had POC Cr > 150 umol/L and 18 out 50 (36%) were attributed to AKI. In the third stage, 69 patients aged 38±14 diagnosed with COVID-19 were screened irrespective of symptoms. 21.7% were females and 1.4% had known CKD. 8 out of 61 (11.6%) had POC Cr > 150 umol/L attributed to AKI. COVID-19 associated AKI was associated with older age, higher respiratory rate, lower oxygen saturations and higher systolic blood pressure (55±11 vs 35±12 p <.001, 26±7 vs 21±2 p <.001, 88%±7 vs 97±3 p <.001 and 141±12 vs 124±15 p 0.002 respectively). Conclusions: POC Cr technology detected AKI in one third of patients with high-risk clinical presentation and can be a valuable and possibly cost-effective tool to assist clinical decision making regarding early interventions and triage decisions in the ED and in the community setting. In patients diagnosed with COVID-19, AKI was present in 1 out of 10 of patients irrespective of symptoms and was associated with clinical observations indicating disease severity. Conflict of interest Potential conflict of interest: I declare that the point of care creatinine device was provided by Nova in support of early detection and management of AKI.