Acute kidney injury in the era of the AKI e-alert

Abstract

© 2016 by the American Society of Nephrology. 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 3.06million.Datawere 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 1.73m2 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.