Table 3.

Large Clinical Outcomes Studies Evaluating the Effect of AKI by Real-Time e-alerts Based on KDIGO definition.

Study	N	Study Design	Baseline sCr	Major findings in terms of clinical outcome or patient management
Wilson et al., 2015 [17]	2393 (AKI alert arm = 1201; Usual care, no AKI alert arm = 1192)	Single blind, parallel group randomized trial.	Lowest value within past 7 days.	There were no real benefits to implementing e-alerts in a US healthcare setting, as it did not have significant effect on primary outcomes measured (maximum sCr change, dialysis need, and death at 7 days).
Al-Jaghbeer et al., 2018 [96]	528 108 (Prealert: 181 696; Postalert: 346 412)	Multicenter, observational evaluation of data collected during Prealert vs Postalert period.	Lowest value in the past 12 months. If no baseline available, then baseline was estimated from eGFR based MDRD equation.	The authors found that a small, but sustained decrease was evident in hospital mortality, length of stay and dialysis rate for patients after postalert implementation.
Selby et al., 2019 [65]	20 179 (24 049 AKI episodes; 14 042 episodes in control period; 10 017 episodes in intervention)	Multicenter, stepped-wedge cluster randomized trial.	Lowest value in the past 7 days or a median of values from 8 to 365 days.	Authors evaluated whether a multifaceted intervention that consisted of AKI e-alerts, clinical chemists phoning stage 2 and 3 AKI, coupled with an AKI care bundle and an education program would improve delivery of care and patient outcomes. Evident was the reduction in length of stay and improvement of quality of care. No reduction in 30 day mortality was observed.
Aiyegbusi et al., 2019 [80]	3462 (Prealert: 2257) (Postalert:1205)	Observational evaluation of data collected during pre-alert vs post-alert study.	Lowest value in the past 7 days or a median of values from 8 to 365 days.	AKI alert systems in primary care with the KDIGO modified rules led to higher rates of sCr monitoring and hospitalization rates.
Barton et al., 2020 [81]	2742 (Prealert: 991) (Postalert: 1751)	Observational evaluation of data collected during pre-alert vs post-alert study.	Lowest value in the past 7 days or a median of values from 8 to 365 days.	AKI alert systems in primary care with the KDIGO modified rules in the UK had beneficial impact on patient management and outcome (i.e., follow-up on patients, hospital length of stay and mortality rate).
Wilson et al., 2021 [16]	6030 (AKI alert arm = 3059; Usual care, no AKI alert arm = 2971)	Double blinded, multicenter, parallel, randomized controlled trial.	Lowest value within past 7 days.	There were no recognizable benefits to implementing e-alerts that were informational in nature, as it had no effect on the risk of progression of AKI, dialysis, or death. In non-teaching hospitals, alerts may even be harmful.