The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

Hazara, Adil M.; Elgaali, Musab; Naudeer, Sarah; Holding, Stephen; Bhandari, Sunil

doi:10.1159/000454779

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…This study has demonstrated that the combination of sCA-I and CA-AKI is present in 3.4% of non-elective hospital attendances and is associated with worse outcomes (30-day all-cause mortality, LOS and admission to ICU) than either CA-AKI or sCA-I on their own. The incidence of CA-AKI in this study (5.7%) and the 30-day mortality rate (21.9%) for the whole group is similar to other published studies [5,19]. In this study population the majority (58.8%) of CA-AKI cases were treated with antibiotics for suspected infection.…”

Section: Discussionsupporting

confidence: 89%

The importance of acute kidney injury in suspected community acquired infection

Tollitt¹,

Bennett²,

Darby³

et al. 2019

PLoS ONE

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Background Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes. Methods All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median. Results Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21–7.12, OR 12.52 CI: 10.54–14.88 and OR 8.97 CI: 7.62–10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91–12.33, OR 29.26 CI: 22.46–38.18 and OR 9.48 CI: 6.82–13.18 respectively. Conclusion The combination of sCA-I and CA-AKI is associated with worse outcomes.

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Section: Discussionsupporting

confidence: 89%

The importance of acute kidney injury in suspected community acquired infection

Tollitt¹,

Bennett²,

Darby³

et al. 2019

PLoS ONE

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“…an increase in serum creatinine by at least 0.3 mg/dl within 48 hrs (if baseline serum creatinine < 1.2 mg/dL) or increase in serum creatinine to at least 1.5 times baseline within the prior 7 days ( Table S1 ). AKI was initially defined as CA-AKI if the increase in serum creatinine was observed during the first 48 hrs of hospitalization 3,15. It was deemed that this approach may not detect AKI originating in a community setting, with patients having a high serum level of creatinine at the time of hospital admission.…”

Section: Methodsmentioning

confidence: 99%

“…CA-AKI account for 54.5% to 79.4% of AKI cases 14–17. Detection and prevention of CA-AKI are important because the mortality rates associated with CA-AKI measure 25% at 30 days and 45% at 3 years 3,4. Prevention mainly focusses on improving the prescription of drugs and strengthening their monitoring12 as 59.9% to 72.0% of CA-AKI are induced by drugs 16,18…”

Section: Introductionmentioning

confidence: 99%

<p>Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event</p>

Robert¹,

Ficheur²,

Gautier³

et al. 2019

CIA

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PurposeCommunity-acquired acute kidney injury (CA-AKI) is a frequent and severe adverse drug reaction (ADR) among older patients. The combination of drugs and other CA-AKI risk factors was barely evaluated. The objectives of our study were to both accurately identify CA-AKI induced by drugs in older patients, and to describe their combination with other risk factors.Patients and methodsWe conducted a retrospective, single-center study in a general hospital over a two-year period. An automated detection identified CA-AKI according to KDIGO criteria, amongst 4,767 eligible inpatient stays among patients aged 75 years or older. Two independent experts reviewed all CA-AKI events to adjudicate drug involvement (Naranjo scale), identify inappropriate prescriptions (STOPP criteria), evaluate avoidability (Hallas criteria) and identify combined risk factors.ResultsAn expert review confirmed 713 CA-AKI (15.0% of inpatient stays) and determined that 419 (58.8%) CA-AKI were induced by drugs. A multifactorial cause (i.e., at least one drug with a precipitating factor) was found in 63.2% of drug-induced CA-AKI. Most of the drug-induced events were avoidable (66.8%), mainly in relation to a multifactorial cause.ConclusionDrug-induced CA-AKI were frequent, multifactorial events in hospitalized older patients and their prevention should focus on combinations with precipitating factors.

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“…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]. Similar alerts could be implemented at the primary care level, before the patient requires observation at the hospital, to encourage physicians to provide appropriate education to patients with CA-AKI, to refer patients to nephrologists and/or to discuss the implementation of a cardiorenal protective diet [29, 30].…”

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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The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

Cited by 6 publications

References 21 publications

The importance of acute kidney injury in suspected community acquired infection

The importance of acute kidney injury in suspected community acquired infection

<p>Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event</p>

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

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