Use of an electronic alert to identify patients with acute kidney injury

Abstract

Early intervention in the management of acute kidney injury (AKI) has been shown to improve outcomes. To facilitate early review we have introduced real time reporting for AKI. An algorithm using the laboratory computer system was implemented to report AKI for inpatients. Over 6 months there were 1,906 AKI reports in 1,518 patients: 56.3% AKI1, 26.9% AKI2 and 16.8% AKI3. 51.0% were male. Median age was 78 (interquartile range [IQR] 17) years. 62.6% were from general medical wards, 16.9% from surgical wards, 6.9% from orthopaedic wards and 5.3% from specialty wards. 8.3% were from peripheral hospitals. 31% of patients with AKI reports were clinically coded for AKI. 9% (n = 139) showed progression of AKI (mortality 42%). Patients with AKI had a signifi cantly higher length of stay and mortality than those that did not. 4% of patients with AKI received acute renal replacement therapy (RRT). An e-alert system is feasible, allowing early identifi cation of inpatients with AKI.

One Year's Observational Study of Acute Kidney Injury Incidence in Primary Care; Frequency of Follow-Up Serum Creatinine and Mortality Risk

“…The patients were predominantly elderly with a fairly even split in females to males, consistent with previous reports [1,8,11,15]. The staging breakdown was also similar to inpatient studies [1,11].…”

“…AKI encompasses a wide clinical spectrum, from minor changes in kidney function to the requirement for renal replacement therapy [5,7]. It is a potentially serious and life threatening condition, often associated with an increased length of hospital stay [1,2,3,5,7,8]. Depending on the severity of renal damage and other comorbidities, mortality rates can range from 15 to 40% [4,5,6].…”

“…Acute kidney injury (AKI) is identified in approximately 3-20% of all patients admitted to hospital [1,2,3,4,5] and each year costs the United Kingdom (UK) National Health Service (NHS) an estimated GBP 434-620 million [2,6]. AKI encompasses a wide clinical spectrum, from minor changes in kidney function to the requirement for renal replacement therapy [5,7].…”

“…Furthermore, post-AKI patients are at a higher risk of developing chronic kidney disease (CKD) [1,2,3,4,7,8,9], or future progression to dialysis [1,2,3,4,7,8]; approximately 13% of those requiring dialysis during an AKI episode remain dependent [4]. Therefore, early recognition and treatment is vital to promote reversal of renal injury and prevent complications [1,2,3,4,5,7,8]. In 2007, the consensus ‘Acute Kidney Injury Network' (AKIN) criteria were produced to aid the identification of AKI and define its staging [7].…”

The Effects of Acute Kidney Injury on Long-Term Renal Function and Proteinuria in a General Hospitalised Population

“…We wished to develop a methodology that addressed these concerns and our results demonstrate that our methods were both practical and acceptable to participants. The automated process of patient identification helped to improve efficiency beyond traditional face-to-face recruitment procedures whilst at the same time producing a study population that is representative of the majority of general hospitalised patients with AKI [21,22]. Recruitment rates were acceptable, even when benchmarking against observational studies that required no input from patients other than permission to access medical records [23].…”