Linking systems of acute kidney injury
Working with animal models of AKI, Drs. Soranno and Faubel are finding it affects almost everything: the lungs, heart, liver, even the spleen. One of its more disastrous effects is immune dysfunction.
Kids who undergo the Norwood and develop AKI are three and a half times more likely to get a post-surgical infection, independent of other factors, Drs. Gist, Soranno and Faubel found. They published their results in Pediatric Nephrology last fall. In Children’s Colorado's Pediatric Kidney Injury and Disease Stewardship program, or PKIDS, they collaborate with neonatologist Jason Gien, MD, to study AKI in intensive care through a large bank of blood and urine samples collected from every consenting patient across Children’s Colorado's three ICUs.
The effort, however, is campus-wide. Wrapping in pediatric and adult specialists from neonatology, cardiology, surgery, anesthesiology, pulmonology, infectious disease and critical care, the Multidisciplinary Translational Research in Acute Kidney Injury Collaborative, or M-TRAC, acts as a research umbrella across institutions. And their retrospective studies of AKI suggest the long-term consequences may be even farther flung: stroke, blood clots, fractures.
"If you're going to make these associations, they should work in mice, in neonates, in kids, in adults," says Dr. Faubel. "We're trying to make those links among all these different populations."
The cost of acute kidney injury
In additional hospital costs for patients with AKI
Overall mortality rate for patients with AKI
Patients who sustain even one episode of AKI spend more time in the hospital, more time on ventilators, more time in intensive care. One study estimated the additional hospital cost at $70,000 — and that doesn't even account for the long-term, system-wide consequences.
"It's actually safer to have a heart attack," says Dr. Soranno. "And we've probably seen just the tip of the iceberg. We haven't even looked at the big picture data."
That's not because the data isn't there. Continuous renal replacement therapy (CRRT) machines, standard in ICUs, offer vast, largely unexplored repositories of information. The electronic medical record, too, offers reams of longitudinal data just waiting to be parsed. The question is how to parse it.
Leveraging Health Data Compass
"Five years ago, if a researcher wanted to compare EMR data from UCHealth and Children's Colorado, they'd have to submit two different requests to both institutions, manually curate the data and then do the analysis," says Sarah Davis, principal informatics analyst for Health Data Compass, a company set up on the Anschutz Medical Campus to do just that.
"For physician researchers, that would take all of our lives," says Dr. Faubel. "For them it's just more code."
Soon, that code will pull de-identified EMR data from Children's Colorado, University of Colorado systems and public health records to flow everything from patient history to electrolyte levels to CRRT effluent into a convenient dashboard for M-TRAC researchers. Led by Dr. Soranno, it's been the largest-scale project in Health Data Compass's five-year history.
"We gave them a huge document of variables and variables and variables," says Dr. Soranno. "The database searches diagnostic codes, so we had to come up with literally hundreds of definitions. It really was tedious. But that was where the collaboration really paid off. Everyone got a chance to include what they wanted. We came up with 300 variables altogether."
Launching an acute kidney injury database
"A lot of it is flow sheet data," says Davis. "So, for example, you could enter heart rate into the flow sheet every ten minutes and have minute-by-minute tracking of all these outcomes. It's a great way to capture complex data elements over time. But the scope was definitely challenging."