Abstract: FR-PO064

Initial Application of Electronic Alert for AKI among High-Risk Wards

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Wu, Yanhua, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  • Chen, Yuanhan, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  • Dong, Wei, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  • Liang, Xinling, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

Group or Team Name

  • China collaborative study on AKI
Background

The effectiveness of acute kidney injury alert might differ in different care settings. We aimed to investigate the value of electronic alert for acute kidney injury among high-risk wards.

Methods

A prospective, randomized, controlled study was conducted. We developed an electronic alert for AKI and ran the system in intensive care units and cardiovascular departments. Eligible participants were adults aged 18 years or older who were in hospital with acute kidney injury as defined by Kidney Disease Improving Global Outcomes creatinine-based criteria. Exclusion criteria were initial hospital creatinine 353.6µmol/L or greater, end-stage renal disease, renal replacement therapy before randomization, kidney transplantation and amputation. The primary outcomes were AKI and expanded AKI diagnosis rates, nephrology consultation, dialysis, recovery of renal function and death. Patients were randomly assigned to alert group and non-alert group. Alert group could receive popup messages. This study is registered with ClinicalTrials.gov, number NCT02793167.

Results

Between Mar.1 2016 and Jul.31 2016, 5535 patients were screened.318 eligible participants were assigned to the alert group and 623 were assigned to the non-alert group. The diagnosis rate of AKI in alert group was higher than non-alert group(5.6% vs. 2.1%,P=0.004).The expanded AKI (AKI and multiple organ dysfunction syndrome) diagnosis rate was also higher in alert group (11.2% vs. 4.5%,P<0.001).Patients were stratified according to the severity of AKI and different wards. At AKI stage 1, the AKI and expanded AKI diagnosis rates in alert group were higher than non-alert group (AKI: 2.8% vs. 0.8%,P=0.037;expanded AKI: 4.7% and 1.3%, P=0.011).There was no difference at AKI stage 2 and stage 3. Among the different wards, the AKI alert had greater impact on AKI and expanded AKI diagnosis rates in cardiovascular surgery wards(AKI:3.9% vs. 1.2%,P=0.077; expanded AKI:9.0% vs. 2.9% , P=0.003).There was not significantly different in nephrology consultation, dialysis, recovery of renal function or death in the two groups.

Conclusion

Electronic warning system could reduce the misdiagnosis rates of AKI and expanded AKI in high-risk wards. Standard diagnosis rate of AKI was still very low. The electronic alert system for AKI did not improve clinical outcomes in these wards.

Funding

  • Government Support - Non-U.S.