Bibliographic Details
| Title: |
Early, Individualized Recommendations for Hospitalized Patients With Acute Kidney Injury: A Randomized Clinical Trial. |
| Authors: |
Aklilu, Abinet M.1,2 (AUTHOR), Menez, Steven3 (AUTHOR), Baker, Megan L.2 (AUTHOR), Brown, Dannielle4 (AUTHOR), Dircksen, Katie K.4 (AUTHOR), Dunkley, Kisha A.4 (AUTHOR), Gaviria, Simon Correa3 (AUTHOR), Farrokh, Salia4 (AUTHOR), Faulkner, Sophia C.1 (AUTHOR), Jones, Charles5 (AUTHOR), Kadhim, Bashar A.1,6 (AUTHOR), Le, Dustin7 (AUTHOR), Li, Fan1,8 (AUTHOR), Makhijani, Amrita1 (AUTHOR), Martin, Melissa1 (AUTHOR), Moledina, Dennis G.1,2 (AUTHOR), Coronel-Moreno, Claudia1 (AUTHOR), O'Connor, Kyle D.1 (AUTHOR), Shelton, Kyra1 (AUTHOR), Shvets, Kristina5 (AUTHOR) |
| Source: |
JAMA: Journal of the American Medical Association. 12/24/2024, Vol. 332 Issue 24, p2081-2090. 10p. |
| Subject Terms: |
*ACUTE kidney failure, *ELECTRONIC health records, *CLINICAL trials, *HOSPITAL patients, *BLACK people, *MONITOR alarms (Medicine) |
| Abstract: |
Key Points: Question: Among hospitalized patients with acute kidney injury, do diagnostic and therapeutic recommendations sent by a kidney action team through the electronic health record prevent the primary outcome of worsening kidney injury stage, dialysis, or mortality? Findings: In this randomized clinical trial involving 4003 patients hospitalized with acute kidney injury, the intervention did not reduce the primary outcome compared with usual care (19.8% for intervention vs 18.4% for usual care. Meaning: These results do not support a kidney action team to prevent worsening kidney injury, dialysis, or death among patients hospitalized with acute kidney injury. Importance: Acute kidney injury (AKI) is a common complication during hospitalization and is associated with adverse outcomes. Objective: To evaluate whether diagnostic and therapeutic recommendations sent by a kidney action team through the electronic health record improve outcomes among patients hospitalized with AKI compared with usual care. Design, Setting, and Participants: Randomized clinical trial conducted at 7 hospitals in 2 health systems: in New Haven, Bridgeport, New London, and Waterbury, Connecticut, and Westerly, Rhode Island; and in Baltimore, Maryland. Hospitalized patients with AKI were randomized between October 29, 2021, and February 8, 2024. Final follow-up occurred February 22, 2024. Intervention: An alert about AKI was sent to the kidney action team, consisting of a study physician and study pharmacist, which sent personalized recommendations through the electronic health record in 5 major categories (diagnostic testing, volume, potassium, acid base, and medications) within 1 hour of AKI detection. The note was immediately visible to anyone with access to the electronic health record. Randomization to the intervention or usual care occurred after the recommendations were generated, but the note was only delivered to clinicians of patients randomized to the intervention group. Main Outcomes and Measures: The primary outcome was a composite outcome consisting of AKI progression to a higher stage of AKI, dialysis, or mortality occurring while the patient remained hospitalized and within 14 days from randomization. Results: Of the 4003 patients randomized (median age, 72 years [IQR, 61-81 years), 1874 (47%) were female and 931 (23%) were Black patients. The kidney action team made 14 539 recommendations, with a median of 3 (IQR, 2-5) per patient. The primary outcome occurred in 19.8% of the intervention group and in 18.4% in the usual care group (difference, 1.4%, 95% CI, −1.1% to 3.8,% P =.28). Of 6 secondary outcomes, only 1 secondary outcome, rates of recommendation implementation, significantly differed between the 2 groups: 2459 of 7270 recommendations (33.8%) were implemented in the intervention group and 1766 of 7269 undelivered recommendations (24.3%) were implemented in the usual care group within 24 hours (difference, 9.5%; 95% CI, 8.1% to 11.0%). Conclusions and Relevance: Among patients hospitalized with AKI, recommendations from a kidney action team did not significantly reduce the composite outcome of worsening AKI stage, dialysis, or mortality, despite a higher rate of recommendation implementation in the intervention group than in the usual care group. Trial Registration: ClinicalTrials.gov Identifier: NCT04040296 This randomized clinical trial tested whether recommendations from a kidney action team tailored to individual patients presenting with acute kidney injury would improve clinical outcomes, kidney function, and mortality. [ABSTRACT FROM AUTHOR] |
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