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Kidney Week

Abstract: FR-PO063

Personalized Recommendations for AKI Using a Kidney Action Team (KAT-AKI): Design, Rationale, and Early Data

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Aklilu, Abinet Mathias, Yale School of Medicine, New Haven, Connecticut, United States
  • O'Connor, Kyle D., Yale School of Medicine, New Haven, Connecticut, United States
  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States

Group or Team Name

  • CTRA (Clinical and Translational Research Accelerator)
Background

AKI is common during hospitalization and is associated with high morbidity and mortality. Although studies have looked at the utility of electronic alerts in improving AKI outcomes, no prior study has evaluated real time, personalized AKI recommendations. Our study aims to assess the impact of individualized AKI-specific recommendations from a trained clinician and pharmacist delivered immediately after electronic detection of AKI in hospitalized patients.

Methods

KAT-AKI is a randomized-controlled trial conducted across 8 hospitals at two major hospital systems. A real-time electronic AKI alert system informs a dedicated team comprising a physician and pharmacist who independently review the chart in real-time, screen for eligibility, and provide AKI-specific recommendations, across the following domains: diagnostics, medications, volume, potassium and acid-base management. Recommendations are delivered to the primary team in the alert arm of the study and logged for future analysis in the usual care arm. The primary outcome is a composite of progression to higher AKI stage, dialysis and mortality 14days after randomization. A key secondary outcome will be percentage of recommendations implemented by the primary care team within 24hours from randomization.

Results

As of May 16, 2022, there were 342 individuals enrolled out of 507 screened. Median(IQR) age was 72.2(60.0,81.5)yrs. 48.8% were female, 12.3% Hispanic and 19.6% were Black. Nearly half(49%) were on a general medical floor at the time of alert and 14.4% were admitted to an ICU. Virtually all participants (99.1%) were recommended to have at least one diagnostic intervention. 180(52.6%) individuals had recommendations to discontinue a medication or to dose-adjust a medication. Of the 90 with medication discontinuation recommendations, 23.3% were on NSAIDs. The median(IQR) time from AKI alert to recommendation was 0.52(0.18,0.90)hr.

Conclusion

Conducting a randomized clinical trial using an electronic AKI alert coupled with a team of clinicians is feasible and generates valuable data about early AKI management.

Frequencies of Selected Personalized Recommendations
RecommendationParticipants with Recommendation, n (%)
N = 342
DIAGNOSTIC
- Obstruction
- Strict I&Os
- Urinalysis
- Other

NEPHROLOGY CONSULT
339 (99.1)
- 222 (64.9)
- 267 (78.1)
- 292 (85.4)
- 236 (69.0)

10 (2.9)
VOLUME
- Empiric challenge
- Assess volume
275 (80.6)
- 64 (18.7)
- 255 (74.6)
MEDICATIONS
- Discontinue
- Dose-adjust
180 (52.6)
- 90 (26.3)
- 122 (35.7)

Funding

  • Other U.S. Government Support