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Abstract: FR-OR019

Electronic Alert and a Bundle of Care Reduces Progression and Mortality of AKI Patients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Tome, Ana carolina Nakamura, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Ponte, Bianca, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Agostinho, Helga, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Dos santos, Karise Fernandes, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Machado, Mauricio, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Abbud-Filho, Mario, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Ramalho, Rodrigo J., Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
  • Lima, Emerson Quintino, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Sao Paulo, Brazil
Background

Acute kidney injury (AKI) is potentially preventable but its early diagnosis is essential to ensure appropriate management. The aim of this study was to evaluate the impact of an electronic AKI alert and a bundle of care (BoC) in the progression and mortality of patients with AKI.

Methods

An algorithm examined all serum creatinine reported by the laboratory. An alert was issued in the electronic medical record (accessed by physicians and nurses) and a BoC was suggested in case of AKI (KDIGO criteria). Prescription audit was performed by a clinical pharmacist. Individuals > 18 years were included and patients in palliative care, nephrology and renal transplantation wards were excluded. The study was divided in two periods: pre-alert initiation group (PRE, January-June/2018) and post-alert group (POS, July-December/2018).

Results

3174 patients developed AKI (8.3% of hospitalizations). The PRE (n= 1613) and POS (n=1561) groups were similar in age, gender, serum creatinine, baseline glomerular filtration rate (GFR) and ICU admission rate. Dialysis was performed in 514 patients (15%) and was not different between groups (PRE 14.9% vs POS 15.1%; NS). At the time of AKI alert, the prevalence of KDIGO I was similar between groups (PRE 73.5% vs. POS 75.1%; NS), but a higher number of patients remained at this stage in POS (PRE 51% vs. POS 56.1%, P=0.004). Lower percentage evolved to KDIGO III in POS (PRE 33.3% vs POS 30%, P=0.04). Nephrologist was called to 832 patients (26.2%) and the median time to the consultation was lower in the POS (PRE 1.0 day vs POS 0.0 day; P=0.04). The 30-day mortality was 33.6% and was lower in POS (PRE 36.7% vs 30.5%, P <0.001). The independent 30-day mortality risk factors were: age 40 to <65 years (HR 1.37; CI 1.04-1.81, P = 0.02); age 65 to <75 years (HR 1.72; CI 1.29-2.3, P <0.001), age ≥ 75 years (HR 2.36; CI 1.77-3.14, P = 0.003), ICU admission (HR 1.24; CI 1.08-1.43, P = 0.003), baseline GFR (each increase of 10 mL/min) (HR 0.96; CI 0.94-0.98, P <0.001) and AKI eletronic alert (HR 0.87; CI 0.77-0.98, P = 0.02).

Conclusion

An electronic AKI alert and a multidisciplinary BoC reduced progression and 30-day mortality of patients with AKI.