Trial Outcomes & Findings for Drug-Targeted Alerts for Acute Kidney Injury (NCT NCT02771977)

Recruitment and enrollment was done automatically via our best practice alert, which analyzed hospitalized patients for inclusion and exclusion criteria and, if met, automatically enrolled and randomized patients to the usual care or alert group.

5,839 subjects were assessed for eligibility, with 779 excluded due to either the patient's admission dates being prior to the alert becoming active, the first alert firing after a discharge order, or because the patient was already randomized in a previous hospital admission. 5,060 patients were then randomized to alert versus usual care with zero loss to follow up.

Drug-Targeted Alerts for Acute Kidney Injury

Progression of AKI is defined by an increase in KDIGO creatinine stage from time of randomization to the present. Dialysis is defined by the receipt of hemodialysis, continuous renal replacement therapy or peritoneal dialysis. Isolated ultrafiltration treatments will not be included. Mortality will be determined from hospital records.

The Percentage of patients for whom the targeted agent was discontinued within 24 hours from randomization. For individuals with active orders for more than one targeted agent, cessation of any will be adequate to meet this endpoint.

Percentage of patients who expire within 14 days of randomization

Percentage of patients who expire during index hospitalization.

Receipt of hemodialysis, continuous renal replacement, or peritoneal dialysis within 14 days of randomization

Receipt of hemodialysis, continuous renal replacement, or peritoneal dialysis during index hospitalization

Active orders for dialysis at the point of discharge from the index hospitalization

Progression to stage 2 AKI, represented by a doubling of baseline creatinine levels.

Progression to stage 3 AKI, represented by a tripling of baseline creatinine levels.

Time in hours between AKI onset and AKI cessation during index hospitalization

Number of readmissions within 30 days of discharge from index hospitalization

Total cost of index hospitalization

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.

Percentage of subjects with chart documentation of AKI by post-discharge ICD-10 codes and by chart adjudication