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

Phillips, Dafydd; Young, Oliver; Holmes, Jennifer; Allen, Lucy; Roberts, Gethin; Geen, John; Williams, Julie; Phillips, Aled Owain

doi:10.1111/ijcp.13000

Cited by 21 publications

(31 citation statements)

References 52 publications

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“…Adherence to the allocated times for implementation was excellent across all five sites, and use of the UKRR infrastructure allowed the study to be undertaken efficiently and with independent data collection and analysis. The demographics of the study population were consistent with previous epidemiologic studies, 27,33 and the higher AKI incidence and mortality in winter, recently described elsewhere, 34 were important observations that required adjustment in statistical modeling and have relevance to the design of future studies. The SWCRT is a relatively novel trial design that is increasingly popular, particularly in the evaluation of complex interventions.…”

Section: Discussionsupporting

confidence: 75%

An Organizational-Level Program of Intervention for AKI: A Pragmatic Stepped Wedge Cluster Randomized Trial

Selby

Casula

Lamming

et al. 2019

JASN

140

122

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Background Variable standards of care may contribute to poor outcomes associated with AKI. We evaluated whether a multifaceted intervention (AKI e-alerts, an AKI care bundle, and an education program) would improve delivery of care and patient outcomes at an organizational level. Methods A multicenter, pragmatic, stepped-wedge cluster randomized trial was performed in five UK hospitals, involving patients with AKI aged $18 years. The intervention was introduced sequentially across fixed three-month periods according to a randomly determined schedule until all hospitals were exposed. The primary outcome was 30-day mortality, with pre-specified secondary endpoints and a nested evaluation of care process delivery. The nature of the intervention precluded blinding, but data collection and analysis were independent of project delivery teams. Results We studied 24,059 AKI episodes, finding an overall 30-day mortality of 24.5%, with no difference between control and intervention periods. Hospital length of stay was reduced with the intervention (decreases of 0.7, 1.1, and 1.3 days at the 0.5, 0.6, and 0.7 quantiles, respectively). AKI incidence increased and was mirrored by an increase in the proportion of patients with a coded diagnosis of AKI. Our assessment of process measures in 1048 patients showed improvements in several metrics including AKI recognition, medication optimization, and fluid assessment. Conclusions A complex, hospital-wide intervention to reduce harm associated with AKI did not reduce 30-day AKI mortality but did result in reductions in hospital length of stay, accompanied by improvements in in quality of care. An increase in AKI incidence likely reflected improved recognition.

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Section: Discussionsupporting

confidence: 75%

An Organizational-Level Program of Intervention for AKI: A Pragmatic Stepped Wedge Cluster Randomized Trial

Selby

Casula

Lamming

et al. 2019

JASN

140

122

View full text Add to dashboard Cite

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“…The centralized laboratory-based identification and alerting of AKI in Wales has allowed us to generate a national data set to provide characterization of the epidemiology of AKI in adults. [4][5][6][7][8][9][10][11] Our reported incidence of AKI is significantly higher than previously reported in children. 2,20,21 This likely reflects the methodological differences with a reliance on coding and a focus on hospitalized cases.…”

Section: Significance Of An Aki Alert Based On a Scr Value Within Thementioning

confidence: 61%

Acute Kidney Injury in Children Based on Electronic Alerts

Gubb

Holmes

Smith

et al. 2020

The Journal of Pediatrics

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Objective To define the incidence and outcome of acute kidney injury (AKI) in pediatrics using data collected from a national electronic alert system. Study design A prospective national cohort study was undertaken to collect data on all cases of pediatric AKI, excluding neonates, identified by an e-alert, from April 2015 to March 2019. Results There were 2472 alerts in a total of 1719 patients, giving an incidence of 77.3 per 100 000 person-years. Of the patients, 84.2% of all AKI were stage 1 and 58.3% occurred with a triggering creatinine within the reference range. The incidence of AKI was associated with measures of social deprivation. Thirty-day mortality was 1.7% but was significantly higher in hospital-acquired AKI (2.1%), compared with community-acquired AKI (0.8%, P < .001) and was associated with the severity of AKI at presentation. A significant proportion of patients had no repeat measure of creatinine (39.8%). This was higher in community-acquired AKI (69.7%) compared with hospital-acquired AKI (43.0%, P < .001), and higher in patients alerting with patients triggering with a creatinine within the reference range (48.4% vs 24.5%, P < .001). The majority of patients (84.7%) experienced only 1 AKI episode. Repeated episodes of AKI were associated with increased 30-mortaltiy (11.6% vs 4.6%, P < .001) and higher residual renal impairment (13.3% vs 5.4%, P < .001). Conclusions The results suggest that the significance of the alert is missed in many cases reflecting that a large proportion of cases represent modest elevations in serum creatinine (SCr), triggered by a SCr level that may be interpreted as being normal despite a significant increase from the baseline for the patient.

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“…In this study, we found a significant relationship between the number of deaths due to renal failure and air temperature parameters. Phillips et al reported that the incidence and mortality of acute renal failure were significantly higher between January and March [32]. The mortality due to end-stage renal failure was the highest in January [33].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Air Temperature Parameters and the Number of Deaths Stratified by Cause in Gifu Prefecture, Japan

et al. 2020

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Objective: It is well known that air temperature is closely related to health outcomes. We investigated the relationship between air temperature parameters and the number of deaths stratified by cause in Gifu prefecture, Japan. Methods: The number of deaths stratified by cause in Gifu prefecture Japan between January 2007 and December 2016 was obtained from the official homepage of Gifu prefecture, Japan. Air temperature parameters (°C), i.e., the mean air temperature, mean of the highest air temperature, mean of the lowest air temperature, the highest air temperature, and the lowest air temperature during the same period in Gifu city were also obtained from the Japan Meteorological Agency official home page. The relationship between air temperature parameters and the number of deaths was evaluated in an ecological study. Results: The number of deaths due to heart disease, cerebrovascular disease, pneumonia, accidents, or renal failure in January (coldest winter season in Japan) was the highest among the months. Simple correlation analysis also demonstrated a significant and negative relationship between air temperature parameters and the number of deaths due to heart disease, cerebrovascular disease, senility, pneumonia, accidents, and renal failure. Conclusion: Lower air temperature may be associated with a higher number of deaths due to diseases in Gifu prefecture, Japan.

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

Cited by 21 publications

References 52 publications

An Organizational-Level Program of Intervention for AKI: A Pragmatic Stepped Wedge Cluster Randomized Trial

An Organizational-Level Program of Intervention for AKI: A Pragmatic Stepped Wedge Cluster Randomized Trial

Acute Kidney Injury in Children Based on Electronic Alerts

Relationship between Air Temperature Parameters and the Number of Deaths Stratified by Cause in Gifu Prefecture, Japan

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