Acute kidney injury demographics and outcomes: changes following introduction of electronic acute kidney injury alerts—an analysis of a national dataset. Issue 8 (8th June 2020)

• Record Type: Journal Article
• Authors: Holmes, Jennifer; Donovan, Kieron; Geen, John; Williams, John; Phillips, Aled O
• Is Part Of: Nephrology dialysis transplantation. Volume 36:Issue 8(2021)
• Page Start: 1433
• Page End: 1439
• Publication Date: 2020-06-08
• Subjects: AKI -- epidemiology -- outcomes -- prognosis -- survival analysis; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfaa071
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: Electronic alerts for acute kidney injury (AKI) have been widely advocated. Our aim was to describe the changes in AKI demographics and outcomes following implementation of a national electronic AKI alert programme. Methods: A prospective national cohort study was undertaken to collect data on all cases of AKI in adult patients (≥18 years of age) between 1 April 2015 and 31 March 2019. Results: Over the period of data collection, there were 193 838 AKI episodes in a total of 132 599 patients. The lowest incidence of AKI was seen in the first year after implementation of electronic alerts. A 30-day mortality was highest in Year 1 and significantly lower in all subsequent years. A direct comparison of mortality in Years 1 and 4 demonstrated a significantly increased relative risk (RR) of death in Year 1: RR = 1.08 [95% confidence interval (CI) 1.054–1.114 P < 0.001]. This translates into a number needed to treat in Year 4 for one additional patient to survive of 69.5 (95% CI 51.7–106.2) when directly comparing the outcomes across the 2 years. The increase in the number of cases and improved outcomes was more pronounced in community-acquired AKI, and was associated with a significant increase in patient hospitalization. Conclusions: This study represents the first large-scale dataset to clearly demonstrate that a national AKI alerting system which highlights AKI is associated with a change in both AKI demographics and patient outcomes.