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Kidney Week

Abstract: PO0062

Block Randomized Implementation of a Decision-Making Algorithm for Renal Replacement Therapy Initiation in AKI Compared with Standard Care on AKI-Related Outcomes

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kelly, Yvelynne P., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Ahmed, Salman, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Mandel, Ernest I., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Robinson, Emily S., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McMahon, Gearoid M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Czarnecki, Peter G., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Charytan, David M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • Mendu, Mallika L., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality and utilization. Clinical decision-making related to AKI-RRT initiation in the intensive care setting is not standardized.

Methods

We conducted a 12 month single center block randomized controlled trial in the intensive care units (ICUs) of a large academic tertiary medical center; alternating use of an AKI Standardized Clinical Assessment and Management Plan (SCAMP), a decision-making algorithm to guide front-line clinicians, with use of a “sham” control form in 4-6 week randomization blocks. The SCAMP provided recommendations about optimal indications for initiating RRT on the basis of various clinical parameters, whereas the sham control form did not provide any recommendations for management of AKI-RRT.

Results

122 patients were managed with AKI-SCAMP while 102 patients were managed using the sham control form. There was no significant difference in the primary outcome of odds of inpatient, 30-day or 60-day mortality associated with use of the AKI-SCAMP. With respect to secondary outcomes, use of the AKI-SCAMP resulted in a significantly reduced ICU length of stay (relative risk 0.68; 95% CI 0.66-0.69, p < 0.0001) and hospital length of stay (relative risk 0.75; 95% CI 0.72-0.79, p < 0.0001), as well as a reduced 30-day hospital readmission rate (odds ratio 0.38; 95% CI 0.15-0.99, p = 0.05).

Conclusion

Use of an AKI-SCAMP clinical decision support tool for assessment and management of AKI-RRT led to reduced ICU and hospital length of stay and 30-day hospital readmission rates. We advocate for increased study and use of this clinical decision support tool.

Kaplan-Meier curves for ICU length of stay according to treatment group; censoring for ICU mortality