Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Ruth A. Bush, PhD, MPH, FAMIA, Committee Member; Kathleen Stacy, PhD, RN, APRN-CNS, CCNS, FCN, Committee Member


acute kidney injury, aki, biomarkers, TIMP-2, IGFBP7, Nephrocheck


Background: Acute kidney injury (AKI) is associated with increased mortality, morbidity, length of hospital stay, and in-hospital cost. Timely intervention is needed to prevent disease progression, but the delay in diagnostic process often results in delayed treatment. Recent studies show a significant increase in novel urine biomarkers (UB), TIMP-2 and IGFBP7, has been linked to an increased risk of AKI.

Objectives: The purpose of this study was to examine the relationships among participants’ sociodemographic and clinical characteristics, including select biomarkers, care management processes, treatments, and patient outcomes in a sample of hospitalized critically ill patients in southern California.

Findings: Study results from 383 critically ill adult patients demonstrated almost 40% of the study participants presented with AKI (22.5% AKI stage 1 and 17.2% AKI stage 2-3). During inpatient hospital stay, an additional 26.6% developed AKI, resulting in a total of 66.3% participants are affected by AKI, either upon admission or during hospitalization. Urine biomarkers had significant association with AKI status. Patients with high risk for AKI based on initial, repeat, and peak UB values had a higher incidence of developing AKI stage 2-3 at discharge. Patients with UB peak showing high risk developed AKI stage 2-3 at discharge ten times more (44%) than those with low risk (4.4%). The incidence of AKI stage 2-3 in this study population is almost double when compared to other clinical studies. Mortality was significantly higher for patients with AKI stage 2-3 (55.9%). In contrast, hospital LOS for patients with AKI stage 2-3 (9.76 days) were significantly shorter than those with AKI stage 1 (12.24 days) or no AKI (13.43 days).

Implications: Nurses at the bedside play an important role in detecting changes in patient condition. Significant associations between UB and select factors that contribute to or predispose the patient to develop AKI indicate UB have utility in the early detection of AKI in the clinical setting and can aid in the escalation process of patients’ care, guide treatment, and provide an objective measure of the effectiveness of treatments. If left undetected and untreated, AKI can progress to advanced stages, multi-organ failure, and even death.

Document Type

Dissertation: Open Access