Key result
An AKI electronic alert and care bundle fails to improve 3-month eGFR versus routine care.
Why the study?
Detection and timely intervention of AKI is a major challenge worldwide, and electronic alerts may improve process- and patient-related endpoints.
Does an AKI electronic alert system and care bundle improve renal function in cardiac patients with AKI?
RCT (n=200)
Cluster-randomized
No
Does an AKI electronic alert system and care bundle improve renal function in cardiac patients with AKI?
Absolute Event Rate: 1% vs 0.5%
p-value: p=0.527
An electronic alert system and care bundle for AKI in cardiac patients improved process measures such as medication adjustment and documentation, but did not improve the primary patient-related endpoint of renal function.
AKI alerts plus care bundle failed to improve eGFR in cardiac patients; extends RCTs showing process gains without outcome benefit.
Detection and timely intervention of acute kidney injury (AKI) is a major challenge worldwide. Electronic alerts for AKI may improve process- and patient-related endpoints. The present study evaluated the efficacy of an AKI electronic alert system and care bundle. This is a two-arm, prospective, cluster-randomized, controlled trial enrolling patients with AKI (KDIGO criteria) and cardiac diseases. Patients were randomly assigned to a routine care group or intervention group (DRKS-IDDRKS00017751). Two hundred patients (age 79 years, 46% female) were enrolled, with 100 patients in each group. The primary endpoint did not differ between patients in the routine care group 0.5 (−7.6–10.8) mL/min/1.73 m2 versus patients in the intervention group 1.0 (−13.5–15.1) mL/min/1.73 m2, p = 0.527. Proportions of patients in both study groups with hyperkalemia, pulmonary edema, and renal acidosis were comparable. The stop of antihypertensive medication during hypotensive periods was more frequent in patients in the intervention group compared to patients in the control group, p = 0.029. The AKI diagnosis and text module for AKI in the discharge letter were more frequently documented in patients in the intervention group (40%/48% vs. 25%/34%, p = 0.034; p = 0.044, respectively). Continued intake of RAAS inhibitors and the presence of a cardiac device were independently associated with a less pronounced decrease in eGFR from admission to the lowest value. In this RCT, electronic alerts for AKI and a care bundle improved process- but not patient-related endpoints.
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Iwers et al. (2023) conducted an RCT in Acute kidney injury in cardiac patients (n=200). AKI electronic alert system and care bundle vs. Routine care was evaluated on Change of eGFR from hospital admission to three months after AKI (p=0.527). An electronic alert system and care bundle for acute kidney injury did not significantly improve the change in estimated glomerular filtration rate at 3 months compared to routine care.
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