Flag High

Serum creatinine ?AKI ?CKD RI =Population

Algorithm for detecting Acute result exists? Suggest
Repeat
Reference Interval
Kidney Injury (AKI) based on (Age and sex
related if available)
serum creatinine changes with NO
time
Index creatinine value YES
Defined as Within RI? No flag
This algorithm relates to the C1

NHS England patient safety

alert: NHS/PSA/D/2014/010 NO

Previous result
NO YES
< RI? Flag low
Within 0 – 365 days?

YES

If Result within If Result within

Find lowest Find MEDIAN
0 – 7 days 8 – 365 days
value of results
Then: Then:

Define as
RV = Reference value. Defined as: Define as
RV1 the creatinine value with which an index RV2

creatinine value is compared

Calculate RV ratio Is higher RV ratio Calculate RV ratio

C1 / RV1 ≥ 1.5? C1 / RV2

YES Serum creatinine NO

Is age < 18 years?
> x3 ULRI?
NO YES

ULRI = upper
Report without alert. limit of
NO YES
Send to authorisation Q reference
If creatinine has
Increased > 26 μmol/L
NO Has change occurred
interval
In < 7 days. Within 48hrs?
Consider requesting
Serum creatinine YES ALERT!
repeat If CKD
> 354 μmol/L? ?AKI 3
unlikely.

YES

YES
NO
Report without NO
Is D > 26 μmol/L?
alert
Is higher RV ratio
≥ 3.0?

NO

D = difference between
current and lowest YES
previous result within Alert! YES Is higher RV ratio
?AKI 2 ≥ 2.0 and < 3.0?
48hrs

NO

ALERT! YES Is higher RV ratio

?AKI 1 ≥ 1.5 and < 2.0?
Acknowledgements

Algorithm for detecting Acute Kidney Injury (AKI) based on serum

creatinine changes with time

This algorithm relates to the NHS England patient safety alert:

NHS/PSA/D/2014/010

Conceptual design: Members of the consensus group whose names and

meeting report can be accessed on:

http://www.acb.org.uk/docs/E-Alerts_for_AKI_meeting_statement

Graphic design: Robert Desborough, Mike Bosomworth, Robert Hill