Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study

Park, Sehoon; Baek, Seon Ha; Ahn, Soyeon; Lee, Kee Hyuk; Hwang, Hee; Ryu, Jiwon; Ahn, Shin Young; Chin, Ho Jun; Na, Ki Young; Chae, Dong Wan; Kim, Sejoong

doi:10.1053/j.ajkd.2017.06.008

Cited by 113 publications

(99 citation statements)

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“…Recovery from AKI was defined as a return of serum creatinine to 1.2 times the baseline level. When the criterion of an increase in creatinine of 0.3 mg/dL was the only fulfilled criterion for AKI, the return of serum creatinine concentrations to a 0.2 mg/dL increase from baseline was used to define AKI recovery . In the cases of AKI requiring dialysis, the recovery of AKI was defined when dialysis was no longer needed and the creatinine value after stopping dialysis was less than 1.2 times the baseline.…”

Section: Methodsmentioning

confidence: 99%

“…When the criterion of an increase in creatinine of 0.3 mg/dL was the only fulfilled criterion for AKI, the return of serum creatinine concentrations to a 0.2 mg/dL increase from baseline was used to define AKI recovery. 21,22 In the cases of AKI requiring dialysis, the recovery of AKI was defined when dialysis was no longer needed and the creatinine value after stopping dialysis was less than 1.2 times the baseline. Recovery from 0 to 30 days after AKI was analysed and events with missing serum creatinine follow-up measurements were censored at the last day of the test.…”

Section: Outcome Variablementioning

confidence: 99%

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Hyperuricemia is associated with acute kidney injury and all‐cause mortality in hospitalized patients

et al. 2019

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Aim Hyperuricemia is a risk factor for high morbidity and mortality in several diseases. However, the relationship between uric acid (UA) and the risk of acute kidney injury (AKI) and mortality remain unresolved in hospitalized patients. Methods Data from 18 444 hospitalized patients were retrospectively reviewed. The odds ratio (OR) for AKI and the hazard ratio (HR) for all‐cause mortality were calculated based on the UA quartiles after adjustment for multiple variables. All analyses were performed after stratification by sex. Results The fourth quartile group (male, UA > 6.7 mg/dL; female, UA > 5.4 mg/dL) showed a higher risk of AKI compared with the first quartile group (male, UA < 4.5 mg/dL; female, UA < 3.6 mg/dL), with the following OR: 3.2 (2.55–4.10) in males (P < 0.001); and 3.1 (2.40–4.19) in females (P < 0.001). There were more patients who did not recover from AKI in the fourth quartile compared with the first quartile, with the following OR: 2.0 (1.32–3.04) in males (P = 0.001) and 2.4 (1.43–3.96) in females (P = 0.001). The fourth quartile group had a higher risk of all‐cause mortality compared with the first quartile group, with the following HR: 1.4 (1.20–1.58) in males (P < 0.001) and 1.2 (1.03–1.46) in females (P = 0.019). The in‐hospital mortality risk was also higher in the fourth quartile compared with the first quartile, which was significant only in males (OR, 2.1 (1.33–3.31) (P = 0.002)). Conclusion Hyperuricemia increases the risks of AKI and all‐cause mortality in hospitalized patients.

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Section: Methodsmentioning

confidence: 99%

Section: Outcome Variablementioning

confidence: 99%

Hyperuricemia is associated with acute kidney injury and all‐cause mortality in hospitalized patients

et al. 2019

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“…Automatic electronic alert, based on the laboratory test results and with a prompt on nephrology consultation, would be a promising way to move forward. A recent study from Korea showed that after implementation of an electronic alert system, the frequency of stage 2 or 3 AKI decreased from 32% to 27%, and recovery of kidney function within 30 days increased from 56% to 80% when compared with historic control . Early nephrology consultation was probably the reason of a better outcome as it was associated with lower rates of failure to follow‐up kidney function, and higher rates of recovery of kidney function …”

Section: Epidemiology Of Aki In Hong Kongmentioning

confidence: 99%

“…12 Early nephrology consultation was probably the reason of a better outcome as it was associated with lower rates of failure to follow-up kidney function, and higher rates of recovery of kidney function. 12…”

Section: Practical Problemsmentioning

confidence: 99%

Perspectives on acute kidney injury strategy: Hong Kong

Szeto

2018

Nephrology

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Acute kidney injury is a common condition in hospitalized patients and a strong predictor of short‐term morbidity and mortality. In this article, local epidemiological data on the prevalence and outcome of acute kidney injury amongst hospitalized patient in a tertiary referral center were discussed. The latest practice guidelines endorsed by the Hong Kong College of Physicians will be discussed, with emphasis on local practical issues and problems of guideline implementation.

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“…With advances in the electronic medical record systems, there are options for e-alerts pertaining to CA-AKI [4]. In the hospital setting, e-alerts have been associated with a lower risk of overlooked HA-AKI, severe HA-AKI, improved odds of nephrologist referral, and improved HA-AKI recovery [27]. Similarly, a 3-month descriptive observational study demonstrated the ability to use CA-AKI alerts at the hospital, whether or not patients were actually admitted to the hospital [28].…”

Section: Discussionmentioning

confidence: 99%

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Tecson¹,

Hashemi²,

Afzal³

et al. 2019

Cardiorenal Med

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Objectives: Because patients with hospital-acquired acute kidney injury (AKI) are at risk for subsequent development of heart failure (HF) and little is known about the relation between community-acquired AKI (CA-AKI) and HF, we sought to determine if CA-AKI is a risk factor for incident HF hospitalization. Methods: We utilized Baylor Scott & White Health databases at the primary care and inpatient hospitalization levels to identify adults without a prior history of HF who had 2 or more serum creatinine measurements within 13 months in the primary care setting. We defined CA-AKI as a serum creatinine increase ≥0.3 mg/dL or ≥1.5 times the baseline for consecutive values within a 13-month period. We created a flag for de novo HF hospitalization at 90, 180, and 365 days following CA-AKI evaluation. Results: In the analyses, 210,895 unique adults were included, of whom 5,358 (2.5%) had CA-AKI. Those with CA-AKI had higher rates of comorbidities, higher rate of males (48 vs. 42%, p < 0.001), and were older (61.5 [50.3, 73.1] vs. 54.1 [42.8, 64.7] years, p < 0.001) than those who did not have CA-AKI. In total, 607 (0.3%), 833 (0.4%), and 1,089 (0.5%) individuals had an incident HF hospitalization in the 90, 180, and 365 days following the CA-AKI evaluation, respectively. After adjusting for demographic and clinical characteristics, patients with CA-AKI had >2 times the risk of de novo HF hospitalization compared with patients who did not have CA-AKI (90 days: 2.35 [1.83–3.02], p < 0.001; 180 days: 2.52 [2.04–3.13], p < 0.001; 365 days: 2.16 [1.77–2.64], p < 0.001). These multivariable models yielded strong predictive abilities, with the areas under the receiver-operating characteristic curve >0.90. Conclusion: After controlling for baseline and clinical characteristics, patients with CA-AKI were at approximately twofold the risk of de novo HF hospitalization (within 90, 180, and 365 days) compared with those who did not have CA-AKI. Hence, detecting CA-AKI may provide an opportunity for early intervention at the primary care level to possibly delay HF development.

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Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study

Abstract: Implementation of the AKI alert system was associated with beneficial effects in terms of an improved rate of recovery from AKI. Therefore, widespread adoption of such systems could be considered in general hospitals.

Cited by 113 publications

References 30 publications

Hyperuricemia is associated with acute kidney injury and all‐cause mortality in hospitalized patients

Hyperuricemia is associated with acute kidney injury and all‐cause mortality in hospitalized patients

Perspectives on acute kidney injury strategy: Hong Kong

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

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