OUR RESEARCH WORK: EVALUATION AND USE OF POINT OF CARE CREATININE FOR DETECTION OF ACUTE KIDNEY INJURY IN NIGERIA.

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(Edited)

Hello, and happy weekend to everyone.
In one of my previous posts here,

I mentioned a research work that we carried out. Our research was on the evaluation and use of point-of-care creatinine for the detection of acute kidney injury in Nigeria. So in this post, I will discuss the research in detail and our findings. For further information on what Acute Kidney Injury is all about, please visit my previous post on the rising trends in kidney diseases here

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Image Credit: KI REPORTS page where our work was published

The importance of our study.
Acute kidney Injury is usually of rapid onset and progression. Therefore early detection is so important to halt the progression of the disease. The death rate for patients with Acute Kidney Injury is very high, especially in patients in the Intensive Care Unit (ICU) where the mortality rate is up to 50%. But the good news is that Acute kidney injury (AKI) is potentially reversible when it is detected early. However, this early detection is a problem in middle and low-income countries where side laboratory services are not readily available. The diagnosis of AKI in these places depends on laboratory results which in some cases may take days to get the results. Before the results come and a diagnosis of AKI is made, the kidney damage may have progressed to a point where it cannot be easily reversed.

To facilitate a quick and on-the-spot diagnosis of AKI which will help a quick medical intervention to reverse the injury, our study evaluated the use of point-of-care creatinine for early detection of acute kidney in Nigeria.

Point of care testing is a type of test done right there at the place and time of patient's care or at the patient's bedside. This is why it is also called bedside testing. Point-of-care testing is a diagnostic test, so it helps us to make a diagnosis right there and also take a quick decision on what to do. These provide immediate results. This is better than the conventional laboratory tests where you take a sample from the patient, transport it to the laboratory, then wait for many hours or days before getting the result. So the use of Point of Care Creatinine testing will provide an immediate result compared to laboratory Creatinine testing which will take a longer time. And time is of great essence in AKI management.

Methodology and results
This research is a collaborative study between the UK and Nigerian renal center and we conducted it in two phases:

Phase 1: Phase one of this study was conducted at Salford Royal Hospital, UK to evaluate the accuracy of the Point Of Care Creatinine technology compared with Standard laboratory assay.

During the first stage of the study, the accuracy of POC Cr technology compared with standard laboratory assay (Jaffe) was evaluated in 96 concurrent capillary (POC Cr) and venous samples provided by adult patients attending regular phlebotomy. Pearson correlation was r = 0.956, and Bland-Altman plot mean bias was 27.2 μmol/l. The results of the evaluation phase were reviewed in an AKI workshop including 85 primary and secondary care physicians, and an algorithm was developed for the use of POC Cr, using an adjusted cutoff value for AKI diagnosis in clinically suspected CA-AKI.

The cut-off for likely AKI in the absence of known Chronic Kidney Disease was set at a Point of Care Creatinine value greater than 150 μmol/l.

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Image Credit: KI REPORTS page where our work was published

Figure 1(a) Bland-Altman plot depicting graphical agreement between POC Cr and laboratory Cr. (b) Risk stratification algorithm for adults with suspected AKI. Limits of agreement for the Bland-Altman plot were set at mean ± 2 SD laboratory Cr-laboratory creatinine. POC Cr > 150 μmol/l was determined by the workshop as a cutoff of likely AKI (in the absence of known CKD) taking into consideration the upper normal limit of the laboratory assay (120 μmol/l) adjusted for the POC Cr mean bias of 27.2 ± 47.94.

Phase 2: In this stage, we used this algorithm to investigate the use of Point of care creatinine in the Accident and Emergency Unit of our renal unit here in Nigeria. Due to the possibility of AKI in COVID-19 patients, we later extended the study to the COVID-19 isolation center here.

The second stage of the study investigated the use of POC Cr in the emergency department in adult patients with clinically suspected Community Acquired-AKI based on this algorithm before expanding its use to community centers. Of 53 patients screened with POC Cr, 18 (36%) were diagnosed with having CA-AKI, 6 (11%) afforded blood tests, and 14 (26.4%) were self-discharged owing to lack of affordability. With the emergence of the COVID-19 pandemic, the project was modified to include POC Cr for CA-AKI screening in the regional isolation centers irrespective of symptoms. Of 69 COVID-19–positive patients screened with POC Cr, 8 (11.6%) had AKI, and the presence of AKI was associated with low oxygen saturation and a history of hypertension.

In the end, we were able to make a total diagnosis of 26 AKI patients out of 122 patients screened at both the emergency unit and the isolation center.

In summary, Point of Care Creatinine can be used for the early detection of Acute kidney injury. As a screening tool, it helps physicians to make an early diagnosis of AKI and institute immediate management. With this, we will be able to reduce the morbidities and mortalities associated with Acute Kidney Injury. Through early detection, we will be able to reverse AKI from progressing to the irreversible stage of renal failure or end-stage renal disease where a kidney transplant will be the only definitive treatment.

Recommendation: From the findings in this study, we recommend that the point-of-care creatinine test kits should be made available to all health facilities, both private and government-owned hospitals to enable the screening and early diagnosis of acute kidney injury in at-risk patients.

Acknowledgement: This project was part of the Sister Center Programme supported by the ISN. Point-of-care creatinine devices were provided by the Salford Renal Department and consumables were provided free of charge by NOVA Biomedical. The Greater Manchester Strategic Clinical Network supported the evaluation of point-of-care creatinine technology at Salford Hospital.

I also want to thank my seniors, consultants, and professors of renal medicine for the opportunity to work together in this research.

References:

Kindey International Reports

National Kindey Foundation

National Institute of Health



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(Edited)

Screening remains the baseline for most pathologic conditions. POCTs have greatly enhanced and made diagnosis much easier than before.

They remain indispensable in medical practice. However, they do no and will not in any case replace established standard algorithm and protocols for disease management.

For example, determine for HIV test does not replace ELISA screening especially in cases of positive results.

This was insightful
Well-done 👏👍

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You're absolutely correct Sir @cyprianj

The POCTs just help us to quickly identify individuals that need futher investigations and diagnosis in line with the established diagnostic protocols.

Just like the glucometer too, even though a diagnosis of DM cannot be made just with glucometer values, it has been a great screening tool for diabetes mellitus.

Thank you so much for your wonderful contribution Sir.

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