6282 Automated paediatric eGFR across a children’s hospital

Objectives Creatinine results needs transforming into estimated glomerular filtration rate (eGFR) to be useful clinically: for medication adjustments in kidney impairment, to monitoring acute kidney injury, and to communicate severity of chronic kidney disease to families. In 2019 our children's hospital adopted electronic patient records. Where a height is available this permitted automatic eGFR calculation using the Bedside Schwartz formula 2009 which is internationally the most recognised and accepted for paediatric use (figure 1). We study its utility. Methods Observational, electronic medical record-enabled study of creatinine measurements at our hospital of children ³12 months and <16 years between January 2022 and May 2023. eGFR was automatically calculated and displayed if a height was available within six months. Low eGFR was defined as <90 ml/1.73m²/min. To ascertain clinician response to low eGFR, a subset of medical records of patients with 1–2 eGFR measures were reviewed, with 6 months follow up. Results Over 17 months 41,286 creatinines were measured. Where heights were available, 28,215 (68%) creatinines auto-generated an eGFR in 5,264 children. 58% were generated during 4,309 in-patient or emergency care episodes, remainder during out-patients. 59%, 24%, 9% and 9% of children had one, 2–4, 5–9 or ³10 eGFR measures respectively. 23% of eGFR measures were low with 12.5% 60–89, 5.7% 30–59 and 4.6% <30 ml/1.73m²/min. Low eGFR samples were most prevalent in nephrology (77%), intensive care (19%), cardiology/cardiac surgery (17%) and surgery (9%) samples. Analysis of 1463 children with ³3 eGFR measures showed substantial eGFR change between best and worse valves during study period. Of 1313 children with best eGFR ³90 ml/1.73m²/min, 21% had worse eGFR 60–89 and 7.6% <60. Of 88 children with best eGFR 60–89 ml/1.73m²/min, 41% had worse eGFR <60. We gauged clinician response to low eGFR using a subset of patients with 1–2 measures and available notes. Of 46/514 (8.9%) with low eGFR, 12 did not have eGFR repeated: in eight the creatinine value was within range for age, two were adult sized adolescents, and no reason given in two. Conclusion With electronic patient record and good processes to measure lengths or heights we have shown it is feasible to auto-generate paediatric eGFR. As many children had substantial changes in eGFR the next step will be to study its utility to detect acute kidney injury or to aid medication renal dose adjustments.