Table 2.
Studies on acute kidney injury alerts.
| References | Design | N | Setting | Baseline creatinine definition | E-alert type | Intervention | Key findings |
|---|---|---|---|---|---|---|---|
| Pediatric | |||||||
| Menon et al. (6) | Prospective non-randomized | 239 AKI alerts in 225 patients | Inpatients (non-ICU) aged 6 mo to 18 yo at Seattle Children's Hospital | Lowest in 6 months prior to admission or eCCl 120 mL/min/1.73 m2 | Page to primary provider | AEIOU care bundle | • Increase in AKI documentation, adjustment in medications and fluids • Higher eGFR at discharge and follow-up |
| Gubb et al. (32) | Prospective | 2,472 AKI alerts in 1,719 patients | Inpatients ≥ 25 d-old and <18 yo in Wales | eCCl 120 ml/min/1.73 m2 or midpoint normative creatinine value for age and sex | Displayed in EHR alongside lab result | None | • Higher 30-day mortality in HA- AKI vs. CA-AKI • Repeated AKI episodes associated with increased 30-d mortality and residual renal impairment |
| Holmes et al. (33) | Prospective | 1,343 AKI alerts | Inpatients and outpatients aged <18 yo in Wales | eCCl 120 ml/min/1.73 m2 or midpoint normative creatinine value for age and sex | Displayed in EHR alongside lab result | None | • Greater number of HA-AKI vs. CA-AKI • Improved rate of renal recovery for hospitalized patients |
| Adult | |||||||
| Wilson et al. (34) | Multicenter, randomized, double blind | 3,059 patients in intervention group, 2,971 in usual care group | Inpatient units of 6 hospitals | Lowest in 7 days prior to admission | Pop-up window on EHR | Link to AKI orderset and option to add AKI to problem list | • Overall no change in progression of AKI/death/dialysis • Better AKI documentation • Increased mortality in non-teaching hospitals |
| Holmes et al. (35) | Prospective | 193,838 AKI alerts in 132,599 patients | Inpatient and outpatients >18 yo in Wales | Lowest in last 7 days (HA-AKI) or last 8–365 days (CA-AKI) | Displayed in EHR alongside lab result | None | • Increase in AKI incidence (particularly community-based AKI) • Earlier AKI detection • Improvement in overall mortality |
| Selby et al. (36) | Multicenter stepped wedge cluster randomized | 10,017 AKI alerts | All hospitalized patients >18 yo in five United Kingdom hospitals | Lowest in last 7 days or median of values in prior 8–365 days | Displayed in EHR and phone call to clinic site for AKI stage 2 and 3 | AUDITS care bundle | • Increase in AKI documentation, fluid assessment and adjustment in medications • Decrease in hospital length of stay • No change in 30-d mortality |
| Park et al. (37) | Prospective | 1,739 AKI patients after alert implementation | Non-nephrology inpatients in a tertiary referral hospital in Korea | Lowest within 2 weeks or first measured during hospitalization | Pop-up window on EHR | Automatically generated nephrology consult | • Decrease in overlooked and severe AKI events • Increase in nephrology consultation and AKI recovery • No change in mortality |
| Meersch et al. (29) | Randomized control trial | 138 patients in intervention group, 138 patients in control group | Patients undergoing cardiac surgery with CPB at University of Muenster | None; high risk of AKI defined as TIMP2*IGFBP7 ≥0.3 | None | KDIGO care bundle for cardiac surgery patients | • Reduction in AKI incidence first 72 h after surgery • Improved hemodynamics • Reduction in rate of moderate-severe AKI |
| Al-Jaghbeer et al. (38) and Bataineh et al. (39) | Prospective | 346,412 AKI patients after alert implementation | All inpatients admitted to adult hospitals within University of Pittsburgh Medical Center system | Lowest in prior 12 months or back-calculation from normal eCCl | Displayed in EHR | Prompt to consult nephrology or ICU | • Decrease in hospital mortality rate, hospital duration and dialysis use • Decrease in nephrotoxic antibiotic use |
| Kolhe et al. (40) | Prospective observational | 1,291 AKI patients after alert implementation | All inpatients > 18 yo at the Royal Derby Hospital | Lowest in last 7 days or median of values in prior 8–365 days | Interruptive alert on EHR requiring acknowledgment | AUDITS care bundle | • Improved mortality • Less progression of AKI • Lower odds of death at discharge. |
| Wilson et al. (15) | Single blind parallel group randomized control trial | 1,201 patients in AKI alert group and 1,192 patients in usual care group | All inpatients > 18 yo at the University of Pennsylvania hospital | Lowest in prior 7 days | Page or email to primary provider | Link to external website with KDIGO AKI practice guidelines | • No change in dialysis requirement, nephrology consults, hospital length of stay |
AEIOU, assess cause of AKI, evaluate drug doses, intake and output charting, optimize volume status, urine dipstick; AKI, acute kidney injury; AUDITS, assessment, urinalysis, diagnosis, investigations, treatment, seek advice from nephrologist; CA-AKI, community-associated AKI; CPB, cardiopulmonary bypass; eCCl, estimated creatinine clearance; EHR, electronic health records; HA-AKI, hospital-associated AKI; ICU, intensive care unit; KDIGO, Kidney Disease: Improving Global Outcomes.