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Kidney Week

Abstract: PO2622

Electronic Health Record Alerts for AKI: A MultiCenter Randomized Clinical Trial

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Wilson, Francis Perry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Martin, Melissa, Yale University School of Medicine, New Haven, Connecticut, United States
  • Yamamoto, Yu, Yale University School of Medicine, New Haven, Connecticut, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Greenberg, Jason Henry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Mansour, Sherry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, United States
  • Palevsky, Paul M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Simonov, Michael, Yale University School of Medicine, New Haven, Connecticut, United States
Background

Despite its strong association with adverse clinical outcomes, acute kidney injury (AKI) is often not recognized during clinical care. It is unclear whether automated alerts for AKI imrpove clinical outcomes.

Methods

Double-blinded, multicenter, parallel, randomized, controlled trial of an electronic AKI alert versus usual care (no alert). Adult participants across 6 hospitals were electronically identified and randomized via a best practice alert build in 1:1 fashion to the two study arms. The primary outcome was a composite of AKI progression, receipt of dialysis, or death at 14 days.

Results

6,030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.4%) patients in the alert group and 622 (20.9%) in the usual care group (relative risk 1.02, 95% confidence interval [CI] 0.93 to 1.13, p=0.67). Per-hospital analysis revealed worse outcomes in the two non-teaching hospitals (N=765, 13%), where alerts were associated with a higher risk of the primary outcome of 1.49 (95% CI, 1.12 to 1.98, p=0.006). More deaths occurred at these centers (15.6% in the alert group vs. 8.6% in the usual care group, p=0.003). Certain AKI care practices were increased in the alert group but did not appear to mediate these outcomes.

Conclusion

Alerts did not reduce the risk of our primary outcome among hospitalized patients with AKI. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing AKI alerting systems.

Funding

  • NIDDK Support