Acute Kidney Injury in Primary Care: A Review of Patient Follow-Up, Mortality, and Hospital Admissions following the Introduction of an AKI Alert System

Abstract

Background/Aims: In February 2017, our laboratory implemented an electronic AKI flagging system for primary care using the NHS England AKI detection algorithm. Our study investigated the impact on patient follow-up, hospital admission, length of stay, and mortality. Methods: Primary care results March 2017-February 2018 with an AKI test code were downloaded from the pathology computer. Results: Over 12 months, 1,784 AKI episodes were identified; 81.3% AKI1, 11.3%, AKI2, and 7.5% AKI3. A repeat creatinine was requested within 14 days on 55% AKI1s, 84% AKI2s, and 86% AKI3s. Primary care took the repeat sample in 73.2% AKI1s and 56.7% AKI2s and acute hospital locations for 47.4% AKI3s. Median time to hospital admission was 34 days for AKI1, 6 for AKI2, and 1 for AKI3 (p < 0.05). Length of stay was found to be 1, 2, and 4 days for AKI 1/2/3, respectively (p < 0.05). The 90-day mortality for admitted patients was 15, 18, and 21% for AKI 1/2/3, respectively (p = 0.180). The 90-day mortality for the non-admitted patients was 4, 9, and 50% for AKI 1/2/3, respectively (p < 0.05). AKI patient outcome data pre versus post the start of the AKI flag system were compared. A statistically significant reduction was found in the median length of stay for AKI1 and AKI3 and in mortality for AKI1 and AKI3 patients and for all AKIs as a whole. A further analysis was performed to take into account the difference in pre-and post-alert populations. Mortality overall was significantly improved (p < 0.001), and length of stay was reduced in AKI3 patients (p = 0.048). Discussion/Conclusion: Our study demonstrates that an electronic AKI warning alert system for primary care appears to be associated with a beneficial impact on patient management and outcome.

Alerting to acute kidney injury - Challenges, benefits, and strategies

“…Beyond the algorithm for AKI detection, a consistent nationwide alert system seems like a challenge in North America and the studies published from the UK have generally shown to be beneficial from a detection and alerting standpoint [ 43 , 65 , 73 , [79] , [80] , [81] ]. Some studies as discussed below have also reported improved clinical outcomes [ 65 , 80 , 81 ].…”

“…AKI is also commonly encountered by non-specialized healthcare providers and given the lack of association with any specific symptoms; the syndrome of AKI enables evasion of early detection [ 81 ]. The popularized UK alert system based on modified KDIGO rules [ 71 ], has been extended to primary care in the UK, with the goal to manage community acquired AKI and evaluate impact on patient management and clinical outcome measures [ 80 , 81 ].…”

“…After implementing the e-alerts, it was found that hospital admissions increased, a high proportion of patients had sCr repeated within 14 days, and overall, there was a shorter time to hospital admission. Together this enabled the care to be more proactive [ 81 ]. While 14 days seems like an appropriate retesting interval for sCr, recommendation from a large cohort-based study found 7 days for repeat sCr as an appropriate response to e-alert from primary care [ 82 ].…”

“…This study also suggests that primary care providers are responding earlier, which would enable community acquired AKI to be more optimally managed. Perhaps underappreciated with primary care and e-alerts is also the local education along with a best practice guideline from the “Think Kidneys” campaign [ 83 ] that has led to the improved surveillance and response to AKI alerts [ 80 , 81 ].…”

Catechins: Therapeutic Perspectives in COVID-19-Associated Acute Kidney Injury

“…AKI can lead to serious complications, such as hydro-electrolytic disturbance, alterations in blood pressure control, impairment of acid–base homeostasis, rise of serum concentration of toxic metabolites and increased risk of drug overdose [ 19 , 20 ]. Moreover, AKI contributes to the production of diverse inflammatory mediators and vasoactive agents that play key roles in pathological mechanisms of several diseases [ 21 ].…”