A real-time electronic alert to improve detection of acute kidney injury in a large teaching hospital

Porter, Christine J.; Juurlink, Irene; Bisset, Linda; Bavakunji, Riaz; Mehta, Rajnikant; Devonald, Mark A.J.

doi:10.1093/ndt/gfu082

Cited by 127 publications

(91 citation statements)

References 26 publications

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“…Recently, automatic alert systems have been reported to be helpful in timely AKI diagnosis. 40,41 However, as those systems use current AKI criteria, they will fail to alert clinicians about patients who are at risk for postoperative complications due to increased creatinine levels below AKI criteria, as were identified in our study. The KDIGO clinical practice guideline for AKI recommends a number of measures to undertake in patients at risk of and with AKI, i.e., discontinuation of nephrotoxic agents when possible, ensuring volume status and perfusion pressure, considering functional hemodynamic monitoring, monitoring creatinine and urine output, avoiding hyperglycemia, and considering alternatives to radiocontrast procedures.…”

Section: Discussionmentioning

confidence: 86%

Minor Postoperative Increases of Creatinine Are Associated With Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

Kork

Balzer

Spies

et al. 2016

Survey of Anesthesiology

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Section: Discussionmentioning

confidence: 86%

Minor Postoperative Increases of Creatinine Are Associated With Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

Kork

Balzer

Spies

et al. 2016

Survey of Anesthesiology

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“…Some authors have advocated electronic alert systems to promptly identify patients with AKI. 9 Currently, the serum creatinine still remains the test used for GFR estimation during evolution of AKI.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

Anaele

Suarez

Kennedy-Prieto

et al. 2017

SWRCCC

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Background: Acute kidney injury (AKI) is often one component of multiple organ failure (MOF) in the intensive care unit (ICU Results: Of the 834 critically ill patients, 743 (89%) developed some degree of AKI. Ninetyone percent of the high-risk cohort developed AKI and 87% of the low-risk cohort developed AKI. Patients with AKI had higher mortality at 1 year than patients without AKI (adjusted odds ratio [OR], 2.5; 95% confidence interval, 1.38 to 4.53); P interaction 0.003). Hospital mortality was greater for high-risk patients without AKI than for low-risk patients with AKI.Conclusion: Acute kidney injury occurs at similar frequency in high-and low-risk ICU patients and has significant impact on survival in both groups. Cardiovascular collapse or respiratory failure has greater impact on short term mortality than AKI, but this effect diminishes over time. Conversely, the impact of AKI on mortality increased over time and remained an independent risk factor for mortality.

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“…There are two methods of “imputation”. In 2004, the Acute Dialysis Quality Initiative (ADQI) suggested the use of the estimation of baseline creatinine by solving the Modification of Diet in Renal Disease (MDRD) equation assuming a glomerular filtration rate of 75 ml/min/1.73 m 2 as the baseline SCr, and it has been widely used [17, 18]. However, the specificity of this method for AKI diagnosis was questioned, especially in patients with chronic kidney diseases (CKD).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Three Methods Estimating Baseline Creatinine For Acute Kidney Injury in Hospitalized Patients: a Multicentre Survey in Third-Level Urban Hospitals of China

Lang

Yang

et al. 2018

Kidney Blood Press Res

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Background/Aims: A lack of baseline serum creatinine (SCr) data leads to underestimation of the burden caused by acute kidney injury (AKI) in developing countries. The goal of this study was to investigate the effects of various baseline SCr analysis methods on the current diagnosis of AKI in hospitalized patients. Methods: Patients with at least one SCr value during their hospital stay between January 1, 2011 and December 31, 2012 were retrospectively included in the study. The baseline SCr was determined either by the minimum SCr (SCr_MIN) or the estimated SCr using the MDRD formula (SCr_GFR-75). We also used the dynamic baseline SCr (SCr_dynamic) in accordance with the 7 day/48 hour time window. AKI was defined based on the KDIGO SCr criteria. Results: Of 562,733 hospitalized patients, 350,458 (62.3%) had at least one SCr determination, and 146,185 (26.0%) had repeat SCr tests. AKI was diagnosed in 13,883 (2.5%) patients using the SCr_MIN, 21,281 (3.8%) using the SCr_GFR-75 and 9,288 (1.7%) using the SCr_dynamic. Compared with the non-AKI patients, AKI patients had a higher in-hospital mortality rate regardless of the baseline SCr analysis method. Conclusions: Because of the scarcity of SCr data, imputation of the baseline SCr is necessary to remedy the missing data. The detection rate of AKI varies depending on the different imputation methods. SCr_GFR-75 can identify more AKI cases than the other two methods.

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A real-time electronic alert to improve detection of acute kidney injury in a large teaching hospital

Cited by 127 publications

References 26 publications

Minor Postoperative Increases of Creatinine Are Associated With Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

Minor Postoperative Increases of Creatinine Are Associated With Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

Comparison of Three Methods Estimating Baseline Creatinine For Acute Kidney Injury in Hospitalized Patients: a Multicentre Survey in Third-Level Urban Hospitals of China

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