Acute kidney injury—how does automated detection perform?

Sawhney, Simon; Fluck, Nick; Marks, Angharad; Prescott, Gordon; Simpson, William G.; Tomlinson, Laurie; Black, Corri

doi:10.1093/ndt/gfv094

Cited by 63 publications

(67 citation statements)

References 23 publications

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“…E-alerts that provide real-time notification to the clinicians of the development of AKI in patients have been used in studies involving hospitalized patients, including in those who were admitted to hospital with AKI from the community [9,10] ; these studies however may have excluded the sub-group of patients who were not admitted after presenting to the hospital with acute illness. E-alerts based on modern AKI diagnostic criteria are a sensitive method of detecting AKI [11] . Their use at hospital-based acute assessment areas that take direct referrals from the community in patients at the highest risk of AKI, that is, during acute illnesses, may add further to the growing literature on epidemiology and outcomes of c-AKI.…”

Section: Introductionmentioning

confidence: 99%

The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

Hazara

Elgaali²,

Naudeer³

et al. 2016

Nephron

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Background/Aims: The use of electronic alerts (e-alerts) may increase the detection rate of acute kidney injury (AKI) since they are sensitive to small changes in serum creatinine. Our aim was to follow-up a cohort of patients presenting to hospital from the community with AKI (community-acquired AKI [c-AKI]), detected through the use of e-alerts, and describe their short-term outcomes regardless of whether they were subsequently admitted to hospital. Methods: Blood samples for all hospital attenders from the community either to the Accidents and Emergency department or one of the acute care areas of the hospital during a 6-month period (November 1, 2013-April 30, 2014) were screened for presence of c-AKI using a locally developed e-alerts system based on Kidney Disease: Improving Global Outcomes criteria. Follow-up data were obtained for a period of 3 months. Results: A total of 1,277 c-AKI episodes were identified in 1,185 patients (incidence 579 per 100,000 persons). Episodes that lead to hospitalization (n = 1,096 [86%]) were associated with a median length of hospital stay of 6.6 days; a graded increase in duration of stay was noted with increasing severity of AKI. Acute dialysis was needed during 21 (1.6%) episodes. For mortality rates, only the first AKI episode was considered. There were 298 deaths within 30 days of diagnosis irrespective of admissions status (30-day mortality rate: 25%). Conclusions: Using e-alerts in acute care settings to detect c-AKI is novel and may be used to stage and follow-up AKI using existing diagnostic criteria. c-AKI is relatively common and leads to significant mortality.

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Section: Introductionmentioning

confidence: 99%

The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

Hazara

Elgaali²,

Naudeer³

et al. 2016

Nephron

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“…Uniquely, all biochemistry data are obtained by a single laboratory service regardless of clinical location (inpatient, outpatient, and community), thus minimizing the loss of baseline and follow-up data. We have previously exploited GLOMMS-II to study different approaches to using kidney function data to define AKI in clinical practice and prognostic research 14, 15…”

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confidence: 99%

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Sawhney

Marks

Fluck

et al. 2017

American Journal of Kidney Diseases

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195

189

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BackgroundThe long-term prognosis after acute kidney injury (AKI) is variable. It is unclear how the prognosis of AKI and its relationship to prognostic factors (baseline kidney function, AKI severity, prior AKI episodes, and recovery of kidney function) change as follow-up progresses.Study DesignObservational cohort study.Setting & ParticipantsThe Grampian Laboratory Outcomes Morbidity and Mortality Study II (GLOMMS-II) is a large regional population cohort with complete serial biochemistry and outcome data capture through data linkage. From GLOMMS-II, we followed up 17,630 patients hospitalized in 2003 through to 2013.PredictorsAKI identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine criteria, characterized by baseline kidney function (estimated glomerular filtration rate [eGFR] ≥ 60, 45-59, 30-44, and <30 mL/min/1.73 m2), AKI severity (KDIGO stage), 90-day recovery of kidney function, and prior AKI episodes.OutcomesIntermediate- (30-364 days) and long-term (1-10 years) mortality and long-term renal replacement therapy.MeasurementsPoisson regression in time discrete intervals. Multivariable Cox regression for those at risk in the intermediate and long term, adjusted for age, sex, baseline comorbid conditions, and acute admission circumstances.ResultsOf 17,630 patients followed up for a median of 9.0 years, 9,251 died. Estimated incidences of hospital AKI were 8.4% and 17.6% for baseline eGFRs ≥ 60 and <60 mL/min/1.73 m2, respectively. Intermediate-term (30-364 days) adjusted mortality HRs for AKI versus no AKI were 2.48 (95% CI, 2.15-2.88), 2.50 (95% CI, 2.04-3.06), 1.90 (95% CI, 1.51-2.39), and 1.63 (95% CI, 1.20-2.22) for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m2, respectively. Among 1-year survivors, long-term HRs were attenuated: 1.44 (95% CI, 1.31-1.58), 1.25 (95% CI, 1.09-1.43), 1.21 (95% CI, 1.03-1.42), and 1.08 (95% CI, 0.85-1.36), respectively. The excess long-term hazards in AKI were lower for lower baseline eGFRs (P for interaction = 0.01).LimitationsNonprotocolized observational data. No adjustment for albuminuria.ConclusionsThe prognostic importance of a discrete AKI episode lessens over time. Baseline kidney function is of greater long-term importance.

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“…This includes recognising the potential for ‘false positives’ such as cases of misclassified CKD 1519 20 An assessment of the sensitivity of the NHS England AKI algorithm has been carried out in secondary care but so far, there remain little data on either its specificity or its real-time use in primary care 19. A retrospective review of electronic medical records would help estimate the diagnostic AKI error rate as well as determine the incidence and factors associated with missed diagnostic and management opportunities 44…”

Section: Discussionmentioning

confidence: 99%

“…15 19 20 An assessment of the sensitivity of the NHS England AKI algorithm has been carried out in secondary care but so far, there remain little data on either its specificity or its real-time use in primary care. 19 A retrospective review of electronic medical records would help estimate the diagnostic AKI error rate as well as determine the incidence and factors associated with missed diagnostic and management opportunities. 44 In the majority of UCLA/RAND clinical cases tested through a multidisciplinary professional panel, a wait of up to 72 hours to respond to an AKI warning stage test result was considered to be inappropriate.…”

Section: Principal Findingsmentioning

confidence: 99%

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Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation

et al. 2016

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ObjectivesTackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care.DesignAn appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method.SettingClinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result.ParticipantsA 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and ‘overdiagnosis’.ResultsThere was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia.ConclusionsThe study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs.

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Acute kidney injury—how does automated detection perform?

Cited by 63 publications

References 23 publications

The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation

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