Table 3.

Studies of CDSS for improving renal outcomes

Study	Intervention and study goal	Results
Rind et al. (1994)29	Prospective time-series (before and after implementation) to evaluate the effects of computerized alerts on physicians regarding serum creatinine levels in inpatients receiving potentially nephrotoxic or renally excreted medications	Medication doses changed or discontinued an average of 21.6 h sooner during the intervention period than before implementation of the alert system For patients receiving nephrotoxic medications, the relative risk of renal impairment was 0.45 (95% CI 0.22–0.94)
Chertow et al. (2001)28	Prospective time-series (multiple control and intervention intervals) to evaluate whether CDSS could improve correct drug prescribing (dose and frequency) and outcomes in an inpatient setting	15% of orders were modified by the computer based on renal function Appropriate prescriptions increased during the intervention period: correct dose was 67% vs 54% during the intervention vs control periods, respectively, and correct frequency was 59% vs 35% during the intervention vs control periods, respectively
Nash et al. (2005)54	Prospective cohort study to assess the effectiveness of a computerized alert system for reducing excessive drug dosing in inpatients with CKD Feedback was provided to the prescriber by nurses or pharmacists who reviewed the alerts	Rates of excessive medication dosing at baseline were 23.2%, which decreased to 17.3% with nurse feedback, and to 16.8% with pharmacist feedback
Colpaert et al. (2006)55	Prospective trial to evaluate whether a computer system (Centricity® Critical Care Clinisoft, GE Healthcare, Waukesha, WI, USA) could reduce the incidence and severity of medication prescription errors in an ICU setting	Patients with renal insufficiency assessed with a computer-based system experienced less dosing errors than patients in a paper-based unit (12 vs 35 errors, respectively)
Field et al. (2009)56	Randomized trial to evaluate whether real-time CDSS could improve adherence to drug-dosing guidelines in elderly patients with CKD or AKI in a long-term care facility, and detect excessive medication dosing	Appropriate drug orders were significantly more common with CPOE/CDSS than in the control group (relative risk 1.2, 95% CI 1.0–1.4)
Evans et al. (1998)57	Prospective study to determine whether CDSS using an anti-infective management program could reduce excess doses of antibiotics in the ICU setting	Excess drug dosing significantly decreased in patients with CKD or AKI during and before the intervention period (87 vs 405, respectively; P <0.01)
Roberts et al. (2010)58	Prospective trial to study whether CDSS alerts independent of CPOE could improve drug dosing in an inpatient setting CDSS were used to calculate and update measurements of renal function and adjust drug doses accordingly, as well as for reporting clinically important changes in renal function	Improvements were made in dosing of key medications (enoxaparin, vancomycin and gentamicin), and in therapeutic monitoring of gentamicin During episodes of acute renal impairment, renally cleared drugs were withheld on 38% of cases before the intervention period compared with 62% after the intervention period (P = 0.01)
Matsumura et al. (2009)59	Prospective time-series to study whether CDSS could monitor data from a CPOE system and detect excessive medication dosing and reduce the prescription of medications contraindicated in patients with CKD in the inpatient setting	24% of patients had medication changes before implementation of the alert system compared with 54% after implementation (P <0.01)
Galanter et al. (2005)60	Prospective times-series to study whether CPOE/CDSS could detect excessive medication dosing and reduce the likelihood of receiving renally contraindicated medicine in the inpatient setting	Likelihood of receiving contraindicated medication after implementation of the CPOE/CDSS decreased from 89% to 47% (P <0.01)

Abbreviations: AKI, acute kidney injury; CDSS, clinical decision support systems; CKD, chronic kidney disease; CPOE, computerized physician order entry; ICU, intensive care unit.