403 A Better Insight to Renal Function in Burn Patients: An Automated Calculator Software using the Kinetic eGFR Formula

Abstract

Acute kidney injury is one of the major complications of severe burns and is associated with a high mortality rate. Current guidelines of renal function in acutely ill patients are mainly based on urine output and simple changes in serum creatinine (sCr), which may be inadequate for critically burned patients when renal function is rapidly changing. In order to gain a better insight on kidney function, a more logical approach is to look at the dynamic changes of Glomerular Filtration Rate (GFR) over time, using the kinetic estimated GFR (KeGFR) equation developed by Chen et al, 2013. Evaluations of KeGFR have shown to be a better predictor of AKI and dialysis in critically ill patients. Therefore, KeGFR might be a useful tool if used in conjunction with standard of care. However, manual calculation of KeGFR is tedious and current calculators online only allow two sCr inputs at a time, and show no trends throughout hospitalization. Therefore, we created a more thorough renal function calculator that can automate these calculations and display trending graphs. Additionally, an electronic workbook was created for manual calculations when connectivity is limited. After IRB approval, we created a research tool to automate calculations of the estimated GFR (eGFR) in addition to KeGFR. This desktop application can automatically pull data and sCr values necessary for the equations from an electronic medical record database. Also, all outputs of sCr and eGFR equations can be graphed to show trending values. In addition, a Microsoft Excel workbook was created that can output these equations with graphing capabilities but requires manual entry of sCr values. The application and workbook can easily calculate eGFR and KeGFR from multiple sCr values, are capable of displaying trending graphs (Figure 1) and are quicker than current calculators available out in the market. Additionally, the software can be customized to add additional equations for other research purposes. The tool described here can be used to effortlessly evaluate KeGFR and other factors to better assess renal function in critically ill patients. A dynamic understanding of creatinine in the setting of burn patients is needed rather than a simple static stage based method. We have developed a calculator that allows clinicians to understand renal function easier and faster than current methods.