Understanding Electronic AKI Alerts: Characterization by Definitional Rules

Kidney International Reports

卷:2

Gethin Roberts¹  Soma Meran²  John D. Williams²  Aled O. Phillips²  Jennifer Holmes³ 

[1] Department of Clinical Biochemistry, Hywel Dda University Health Board, Aberystwyth, UK;

[2] Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK;

[3] Welsh Renal Clinical Network, Cwm Taf University Health Board, Caerphilly, UK;

关键词: acute kidney injury;    electronic alerts;    outcome;   

DOI  :  10.1016/j.ekir.2016.12.001

来源: DOAJ

【 摘 要 】

Automated acute kidney injury (AKI) electronic alerts are based on comparing creatinine with historic results.Methods: We report the significance of AKI defined by 3 “rules” differing in the time period from which the baseline creatinine is obtained, and AKI with creatinine within the normal range.Results: A total of 47,090 incident episodes of AKI occurred between November 2013 and April 2016. Rule 1 (>26 μmol/l increase in creatinine within 48 hours) accounted for 9.6%. Rule 2 (≥50% increase in creatinine within previous 7 days) and rule 3 (≥50% creatinine increase from the median value of results within the last 8–365 days) accounted for 27.3% and 63.1%, respectively. Hospital-acquired AKI was predominantly identified by rules 1 and 2 (71.7%), and community-acquired AKI (86.3%) by rule 3. Stages 2 and 3 were detected by rules 2 and 3. Ninety-day mortality was higher in AKI rule 2 (32.4%) than rule 1 (28.3%, P < 0.001) and rule 3 (26.6%, P < 0.001). Nonrecovery of renal function (90 days) was lower for rule 1 (7.9%) than rule 2 (22.4%, P < 0.001) and rule 3 (16.5%, P < 0.001). We found that 19.2% of AKI occurred with creatinine values within normal range, in which mortality was lower than that in AKI detected by a creatinine value outside the reference range (22.6% vs. 29.6%, P < 0.001).Discussion: Rule 1 could only be invoked for stage 1 alerts and was associated with acute on chronic kidney disease acquired in hospital. Rule 2 was also associated with hospital-acquired AKI and had the highest mortality and nonrecovery. Rule 3 was the commonest cause of an alert and was associated with community-acquired AKI.

【 授权许可】

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