Acute Kidney Injury in the Era of the AKI E-Alert

Holmes, Jennifer; Rainer, Timothy; Geen, John; Roberts, Gethin; May, Kate; Wilson, Nick; Williams, Julie; Phillips, Aled Owain

doi:10.2215/cjn.05170516

Cited by 60 publications

(97 citation statements)

References 23 publications

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“…This could be due to limited follow-up time and insufficient power. On the other hand, patients who developed AKI of any etiology were shown to have a higher rate of ESRD (HR 2.57) when compared with those who did not and that is consistent with the known literature [19,20]. Upon comparing mortality and ESRD in patients that developed AKI (NCCT group), PC-AKI and no-AKI to each other (Fig.…”

Section: Discussionsupporting

confidence: 88%

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

Chaudhury

Armanyous

Harb

et al. 2018

Nephron

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Background/Aims: contrast-induced nephropathy (CIN) is well described following an administration of intraarterial contrast, but its occurrence after intravenous (IV) contrast is being questioned. We evaluated the incidence of acute kidney injury (AKI), post-contrast AKI (PC-AKI), CIN, dialysis and mortality in patients with chronic kidney disease (CKD) undergoing non-contrast computed tomography (NCCT) or contrast CT (CCT) or coronary angiography (CoA). Methods: We identified individuals who had CoA or CCT or NCCT between 2010 and 2015 in the Cleveland Clinic CKD registry. We used propensity scores to match patients in the 3 groups. We evaluated the proportion of patients that developed AKI and CIN across the groups with chi-square tests. We generated Kaplan-Meier plots comparing mortality and ESRD among patients who developed AKI (in the NCCT group), PC (multifactorial AKI, CIN) AKI and no AKI. Results: Out of 251 eligible patients, 200 who had CoA were matched to each of the other CT scan groups. The incidence of AKI was 27% in CoA, 24% in CCT and 24% in NCCT (p = 0.72). The incidence of CIN AKI was 16.5% in CoA and 12.5% in CCT (p = 0.26). The Kaplan-Meier survival at 2 years was 74.8 (95% CI 63.8–87.7) for those with CIN and 53.2 (95% CI 39.7–71.4) for those with multifactorial AKI and 56.5 (95% CI 43.4–73.6) for those with AKI-NCCT and 71.4 (95% CI 67.2–76.0) for those without AKI. The Kaplan-Meier ESRD-free estimates at 2 years were 89.9 (95% CI 80.8–100) for those with CIN and 89.4 (95% CI 78.7–100) for those with multifactorial AKI and 77.4 (95% CI 63.6–94.3) for those with AKI-NCCT and 94.4 (95% CI 91.9–97.1) for those without AKI. Conclusion: The administration of both IV and intra-arterial contrast is associated with a risk of AKI. Multifactorial AKI was associated with worse outcomes, while CIN was associated with better outcomes.

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Section: Discussionsupporting

confidence: 88%

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

Chaudhury

Armanyous

Harb

et al. 2018

Nephron

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“…Short-and long-term mortality is increased in CA H -AKI [1,8] although HA-AKI is more likely to result in death [3,10,11] . Talabani et al [5] reported 45% 3-year mortality for CA H -AKI compared to 15.7% ( p < 0.01) in the control cohort with similar figures reported at 5 years (44.6% in Soto et al [7] ).…”

Section: Resultsmentioning

confidence: 99%

“…A similar percentage of non-repeat testing has been reported at 90 days (31%) for all AKI stages [12] . A recent national prospective cohort study demonstrated that CA P -AKI patients who were not hospitalized were more likely to result in CKD than those hospitalized [10] . Sawhney et al [12] reported low short-term mortality (2.6%) for AKI managed in primary care but substantial long-term mortality (46.2%) and a higher rate of progression to chronic RRT at 5 years compared to those admitted to hospital.…”

Section: C-aki Identified In Primary Carementioning

confidence: 99%

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Emmett

Tollitt

McCorkindale

et al. 2017

Nephron

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Background: Almost two-thirds of patients with acute kidney injury (AKI) damage their kidneys whilst in the community. This paper aims to review existing data on incidence, mortality, and morbidity of AKI within the community and explore the evidence base for primary care strategies aimed at reducing incidence and improving early detection and management of AKI. Methods: A literature search was carried out using PubMed; key words including AKI, primary care, community acquired, and electronic alerts (e-alerts) were used to capture relevant data. Results: Incidence of AKI developing in the community is variable between studies due to differences in AKI definition. Community-acquired AKI (CA-AKI) but identified in hospital (CA_H-AKI) is more prevalent than hospital-acquired AKI and increases short- and long-term mortality and length of stay in hospital. CA-AKI identified in primary care is less severe than CA_H-AKI but is associated with increased mortality. The use of e-alerts has good diagnostic accuracy for detecting AKI but their impact on outcomes in secondary care remains uncertain; it is likely that they should be complemented with other interventions to improve management. Evidence has not yet emerged regarding the effects of e-alerts on outcomes in primary care. Conclusion: Given the significance of developing AKI in the community, strategies to aid early detection and promote prevention are warranted. A multifaceted approach combining e-alerts, educational programs, and care bundles across the interface between primary and secondary care has the potential to improve outcomes in the future.

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“…As a result most studies of AKI focus on hospitalised patients, and do not include all community acquired AKI, as a significant proportion of AKI in these settings do not result in hospitalisation . We have previously demonstrated that using the electronic AKI dataset provides a comprehensive characterisation of AKI across both community and hospital settings . Our data therefore provides a comprehensive overview of trends of all cases of AKI defined by changes in serum creatinine.…”

Section: Discussionmentioning

confidence: 99%

“…13 In addition to prompting clinicians to intervene at an early stage, this also provides a valuable source of data regarding the epidemiology of AKI. We have previously used this dataset to report the incidence and outcome of AKI in adult 14 and paediatric Dafydd Phillips and Oliver Young made an equal contribution to this manuscript patients 15 in Wales (UK). More recently we have demonstrated the significance of the electronic AKI alert in primary care.…”

Section: Introductionmentioning

confidence: 99%

Seasonal pattern of incidence and outcome of Acute Kidney Injury: A national study of Welsh AKI electronic alerts

et al. 2017

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SummaryObjectives: To identify any seasonal variation in the occurrence of, and outcome following Acute Kidney Injury. Methods:The study utilised the biochemistry based AKI electronic (e)-alert system established across the Welsh National Health Service to collect data on all AKI episodes to identify changes in incidence and outcome over one calendar year (1st October 2015 and the 30th September 2016).Results: There were total of 48 457 incident AKI alerts. The highest proportion of AKI episodes was seen in the quarter of January to March (26.2%), and the lowest in the quarter of October to December (23.3%, P < .001). The same trend was seen for both community-acquired and hospital-acquired AKI sub-sets. Overall 90 day mortality for all AKI was 27.3%. In contrast with the seasonal trend in AKI occurrence, 90 day mortality after the incident AKI alert was significantly higher in the quarters of January to March and October to December compared with the quarters of April to June and July to September (P < .001) consistent with excess winter mortality reported for likely underlying diseases which precipitate AKI. Conclusions:In summary we report for the first time in a large national cohort, a seasonal variation in the incidence and outcomes of AKI. The results demonstrate distinct trends in the incidence and outcome of AKI.

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Acute Kidney Injury in the Era of the AKI E-Alert

Cited by 60 publications

References 23 publications

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Seasonal pattern of incidence and outcome of Acute Kidney Injury: A national study of Welsh AKI electronic alerts

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