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Clin J Am Soc Nephrol. 2016 Dec 7;11(12):2123-2131. Epub 2016 Oct 28.

Acute Kidney Injury in the Era of the AKI E-Alert.

Author information

1
Welsh Renal Clinical Network, Cwm Taf University Health Board, Caerphilly, United Kingdom.
2
Department of Emergency Medicine and.
3
Department of Clinical Biochemistry, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, United Kingdom.
4
Faculty of Life Sciences and Education, School of Care Sciences, University of South Wales, Pontypridd, United Kingdom; and.
5
Department of Clinical Biochemistry, Hywel Dda University Health Board, Aberystwyth, United Kingdom.
6
Institute of Nephrology, Cardiff University School of Medicine, Cardiff, United Kingdom.
7
Institute of Nephrology, Cardiff University School of Medicine, Cardiff, United Kingdom; Phillipsao@cf.ac.uk.

Abstract

BACKGROUND AND OBJECTIVES:

Our aim was to use a national electronic AKI alert to define the incidence and outcome of all episodes of community- and hospital-acquired adult AKI.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

A prospective national cohort study was undertaken in a population of 3.06 million. Data were collected between March of 2015 and August of 2015. All patients with adult (≥18 years of age) AKI were identified to define the incidence and outcome of all episodes of community- and hospital-acquired AKI in adults. Mortality and renal outcomes were assessed at 90 days.

RESULTS:

There was a total of 31,601 alerts representing 17,689 incident episodes, giving an incidence of AKI of 577 per 100,000 population. Community-acquired AKI accounted for 49.3% of all incident episodes, and 42% occurred in the context of preexisting CKD (Chronic Kidney Disease Epidemiology Collaboration eGFR); 90-day mortality rate was 25.6%, and 23.7% of episodes progressed to a higher AKI stage than the stage associated with the alert. AKI electronic alert stage and peak AKI stage were associated with mortality, and mortality was significantly higher for hospital-acquired AKI compared with alerts generated in a community setting. Among patients who survived to 90 days after the AKI electronic alert, those who were not hospitalized had a lower rate of renal recovery and a greater likelihood of developing an eGFR<60 ml/min per 1.73 m2 for the first time, which may be indicative of development of de novo CKD.

CONCLUSIONS:

The reported incidence of AKI is far greater than the previously reported incidence in studies reliant on clinical identification of adult AKI or hospital coding data. Although an electronic alert system is Information Technology driven and therefore, lacks intelligence and clinical context, these data can be used to identify deficiencies in care, guide the development of appropriate intervention strategies, and provide a baseline against which the effectiveness of these interventions may be measured.

KEYWORDS:

EGFR protein, human; Epidemiology and outcomes; Incidence; Intelligence; Prospective Studies; Receptor, Epidermal Growth Factor; Surveys and Questionnaires; acute kidney injury; acute renal failure; adult; clinical epidemiology; clinical nephrology; cohort studies; humans; kidney

PMID:
27793961
PMCID:
PMC5142071
DOI:
10.2215/CJN.05170516
[Indexed for MEDLINE]
Free PMC Article

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