Optimizing Electronic Alerts for Acute Kidney Injury
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|ClinicalTrials.gov Identifier: NCT02753751|
Recruitment Status : Completed
First Posted : April 28, 2016
Last Update Posted : January 27, 2020
|Condition or disease||Intervention/treatment||Phase|
|Acute Kidney Injury||Other: AKI Alert||Not Applicable|
Acute kidney injury (AKI) carries a significant, independent risk of mortality among hospitalized patients. Recent studies have demonstrated increased mortality among patients with even small increases in serum creatinine concentration. International guidelines for the treatment of AKI focus on appropriate management of drug dosing, avoiding nephrotoxic exposures, and careful attention to fluid and electrolyte balance. Early nephrologist involvement may also improve outcomes in AKI. Without appropriate provider recognition of AKI, however, none of these measures can be taken, and patient outcomes may suffer. AKI is frequently overlooked by clinicians, but carries a substantial cost, morbidity and mortality burden.
The investigators conducted a pilot, randomized trial of electronic alerts for acute kidney injury in 2014. The trial, which randomized 2400 patients with AKI as defined by an increase in creatinine of 0.3mg/dl over 48 hours or 50% over 7 days, found that alerting physicians to the presence of AKI did not improve the course of acute kidney injury, reduce dialysis or death rates. However this study was conducted in a single hospital, and the alert itself did not describe specific actions that a provider could take. In the present proposal, the investigators seek to expand upon their prior study to determine both the modes of alerting that would be most effective and to determine if targeting alerts (such as to patients on medications that may worsen acute kidney injury) will improve effectiveness.
This study will be a randomized, controlled trial of an electronic AKI alert system. Using the Kidney Disease: Improve Global Outcomes creatinine criteria, inpatients at several hospitals will be randomized to usual care versus electronic alerting. The primary outcome will be a composite of progression of acute kidney injury, dialysis and death.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||6030 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Triple (Participant, Investigator, Outcomes Assessor)|
|Primary Purpose:||Supportive Care|
|Official Title:||Optimizing Electronic Alerts for Acute Kidney Injury|
|Actual Study Start Date :||March 26, 2018|
|Actual Primary Completion Date :||January 6, 2020|
|Actual Study Completion Date :||January 6, 2020|
No Intervention: Usual Care
No alert will be fired.
Experimental: Electronic AKI Alert
A pop-up alert will fire when a provider opens the electronic health record of a patient with AKI until such time as AKI is documented in the problem list, or AKI resolves.
Other: AKI Alert
Provider's will receive a "pop-up" alert in the electronic health record until AKI is documented in the problem list or AKI resolves.
- Composite of progression of AKI, inpatient dialysis, or inpatient death [ Time Frame: 14 days from randomization ]
Progression of AKI is defined by an increase in KDIGO creatinine stage from that present at the time of randomization.
Dialysis is defined by the receipt of hemodialysis, continuous renal replacement therapy or peritoneal dialysis. Isolated ultrafiltration treatments (for the purpose of volume removal) will not be included.
Mortality will be determined from hospital administrative records.
- Mortality [ Time Frame: 14 days from randomization ]14-day or inpatient mortality
- Dialysis [ Time Frame: 14 days from randomization ]14-day, inpatient, or discharged on dialysis
- AKI Progression [ Time Frame: 14 days from randomization ]Percent of patients who progress to stage 2 AKI and to stage 3 AKI
- AKI Duration [ Time Frame: 14 days from randomization ]Time in hours between AKI onset and AKI cessation during index hospitalization
- Readmission Rate [ Time Frame: 30 days from randomization ]30 day readmission rate
- Index Hospitalization Cost [ Time Frame: Index hospitalization through discharge ]Cost of index hospitalization
- Proportion of AKI "best practices" achieved per subject during index hospitalization [ Time Frame: 24 hours from randomization to discharge ]
Best practices assessed include: Avoidance of nephrotoxins (cessation of order or absence of de novo order of IV constrast agent, aminoglycoside, NSAID, or ACE inhibitor within 24 hours of randomization), fluid administration (administration of fluids within 24 hours of randomization), urinalysis order (with or without microscopy within 24 hours of randomization), documentation of AKI (by ICD-9 and ICD-10 codes during index hospitalization), monitoring of creatinine (at least one serum creatinine measurement occurring within 36 hours of randomization), documentation of urine output (within 24 hours of randomization), renal consult order during index hospitalization.
Each metric above is binary. Outcome is reported as a composite best practice outcome representing the proportion of best practices achieved per subject.
- Number of subjects with chart documentation of AKI [ Time Frame: Index hospitalization ]Proportion of subjects with chart documentation of AKI by post-discharge ICD-10 codes and by chart adjudication
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02753751
|United States, Connecticut|
|Yale New Haven Hospital|
|New Haven, Connecticut, United States, 06520|
|Principal Investigator:||Francis P Wilson, MD MSCE||Yale University|