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Acute kidney injury in the era of the AKI E-Alert

Holmes, J, Rainer, Timothy, Geen, J, Roberts, G, May, K, Wilson, N, Williams, JD and Phillips, Aled 2016. Acute kidney injury in the era of the AKI E-Alert. Clinical Journal of the American Society of Nephrology 11 10.2215/CJN.05170516

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Abstract

Background and objectivesOur aimwas to use a national electronicAKI 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 3.06 million.Datawere collected betweenMarch of 2015 andAugust 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 systemis 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: acute renal failure clinical epidemiology clinical nephrology Epidemiology and outcomes acute kidney injury adult cohort studies humans Incidence Intelligence kidney Prospective Studies Receptor, Epidermal Growth Factor Surveys and Questionnaires EGFR protein, human
Publisher: American Society of Nephrology
ISSN: 1555-9041
Date of First Compliant Deposit: 14 December 2016
Date of Acceptance: 8 August 2016
Last Modified: 04 Jun 2017 20:01
URI: http://orca-mwe.cf.ac.uk/id/eprint/96334

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