Value of Electronic Alerts for Acute Kidney Injury in High-risk Wards: a Pilot Randomized Controlled Trial

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2018 Mar 21

PMID 29556903

Citations 14

Authors

Yanhua Wu

Yuanhan Chen

Shaowen Li

Wei Dong

Huaban Liang

Miaoyi Deng

Yingnan Chen

Shixin Chen

Xinling Liang

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the application value of "electronic alerts" ("e-alerts") for acute kidney injury (AKI) among high-risk wards of hospitals.

Methods: A prospective, randomized, controlled study was conducted. We developed an e-alert system for AKI and ran the system in intensive care units and divisions focusing on cardiovascular disease. The e-alert system diagnosed AKI automatically based on serum creatinine levels. Patients were assigned randomly to an e-alert group (467 patients) or non-e-alert group (408 patients). Only the e-alert group could receive pop-up messages.

Results: The sensitivity, specificity, Youden Index and accuracy of the AKI e-alert system were 99.8, 97.7, 97.5 and 98.1%, respectively. The prevalence of the diagnosis for AKI and expanded-AKI (AKI or multiple-organ failure) in the e-alert group was higher than that in the non-e-alert group (AKI 7.9 and 2.7%, P = 0.001; expanded-AKI 16.3 and 6.1%, P < 0.001). The prevalence of nephrology consultation in the e-alert group was higher than that in the non-e-alert group (9.0 and 3.7%, P = 0.001). There was no significant difference in the prevalence dialysis, rehabilitation of renal function or death in the two groups.

Conclusion: The e-alert system described here was a reliable tool to make an accurate diagnosis of AKI.

Citing Articles

The computerized algorithm for renal assessment improves diagnostic accuracy of renal impairment in hospitalized patients.

Chen C, Chang T, Chen C, Hsu S, Chu Y, Huang N Sci Rep. 2025; 15(1):3856.

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A Review of Electronic Early Warning Systems for Acute Kidney Injury.

Wang X, Bian Z, Zhu R, Chen S Adv Urol. 2024; 2024:6456411.

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Electronic Alert Systems for Patients With Acute Kidney Injury: A Systematic Review and Meta-Analysis.

Chen J, Lee T, Chan M, Tsai T, Fan P, Lee C JAMA Netw Open. 2024; 7(8):e2430401.

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Chinese experts' consensus on the application of intensive care big data.

Su L, Liu S, Long Y, Chen C, Chen K, Chen M Front Med (Lausanne). 2024; 10:1174429.

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Automated Electronic Alert for the Care and Outcomes of Adults With Acute Kidney Injury: A Randomized Clinical Trial.

Li T, Wu B, Li L, Bian A, Ni J, Liu K JAMA Netw Open. 2024; 7(1):e2351710.

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References

Yang L, Xing G, Wang L, Wu Y, Li S, Xu G . Acute kidney injury in China: a cross-sectional survey. Lancet. 2015; 386(10002):1465-71. DOI: 10.1016/S0140-6736(15)00344-X. View

McCoy A, Waitman L, Gadd C, Danciu I, Smith J, Lewis J . A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report. Am J Kidney Dis. 2010; 56(5):832-41. PMC: 2963668. DOI: 10.1053/j.ajkd.2010.05.024. View

Wilson F, Shashaty M, Testani J, Aqeel I, Borovskiy Y, Ellenberg S . Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. Lancet. 2015; 385(9981):1966-74. PMC: 4475457. DOI: 10.1016/S0140-6736(15)60266-5. View

James M, E Hobson C, Darmon M, Mohan S, Hudson D, Goldstein S . Applications for detection of acute kidney injury using electronic medical records and clinical information systems: workgroup statements from the 15(th) ADQI Consensus Conference. Can J Kidney Health Dis. 2016; 3:9. PMC: 4768328. DOI: 10.1186/s40697-016-0100-2. View

Harel Z, Wald R, Bargman J, Mamdani M, Etchells E, Garg A . Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int. 2013; 83(5):901-8. DOI: 10.1038/ki.2012.451. View

Susantitaphong P, Cruz D, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I . World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. 2013; 8(9):1482-93. PMC: 3805065. DOI: 10.2215/CJN.00710113. View

Mehta R, Cerda J, Burdmann E, Tonelli M, Garcia-Garcia G, Jha V . International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015; 385(9987):2616-43. DOI: 10.1016/S0140-6736(15)60126-X. View

van der Sijs H, Aarts J, Vulto A, Berg M . Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2005; 13(2):138-47. PMC: 1447540. DOI: 10.1197/jamia.M1809. View

Uchino S, Bellomo R, Bagshaw S, Goldsmith D . Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant. 2010; 25(6):1833-9. DOI: 10.1093/ndt/gfp624. View

10.

Aitken E, Carruthers C, Gall L, Kerr L, Geddes C, Kingsmore D . Acute kidney injury: outcomes and quality of care. QJM. 2013; 106(4):323-32. DOI: 10.1093/qjmed/hcs237. View

11.

Coca S, Singanamala S, Parikh C . Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2011; 81(5):442-8. PMC: 3788581. DOI: 10.1038/ki.2011.379. View

12.

Kerr M, Bedford M, Matthews B, ODonoghue D . The economic impact of acute kidney injury in England. Nephrol Dial Transplant. 2014; 29(7):1362-8. DOI: 10.1093/ndt/gfu016. View