Key result
Electronic drug safety algorithm detects AKI during triple whammy therapy with ~88% sensitivity.
Why the study?
The concomitant use of NSAIDs, diuretics, and angiotensin system inhibitors (triple whammy) significantly increases the risk of acute kidney injury, and an electronic algorithm was developed to detect such prescriptions in at-risk patients.
Does an electronic algorithm detecting triple whammy prescriptions accurately identify hospitalized adult patients at risk for acute kidney injury?
Cross-Sectional (n=21,332)
No
Does an electronic algorithm detecting triple whammy prescriptions accurately identify hospitalized adult patients at risk for acute kidney injury?
Effect estimate: Sensitivity 88.3%, Specificity 99.7%
An electronic algorithm can highly sensitively and specifically identify hospitalized patients receiving triple whammy therapy who are at risk for acute kidney injury, facilitating pharmacist-led interventions.
Pharmacist alerts for triple whammy may aid AKI prevention in high-risk patients; leaves open whether outcomes improve without randomized confirmation.
BACKGROUND AND OBJECTIVE: The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician. METHODS: We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint. RESULTS: Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases. CONCLUSION: The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.
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Dahmke et al. (2024) conducted a cross-sectional in Acute kidney injury risk from triple whammy therapy (n=21,332). Electronic drug safety algorithm for Triple Whammy prescriptions was evaluated on Sensitivity and specificity of the algorithm in detecting patients at risk for acute kidney injury (Sensitivity 88.3%, Specificity 99.7%). The electronic drug safety algorithm detected 11 of 12 patients who developed acute kidney injury during triple whammy therapy, demonstrating a sensitivity of 88.3% and a specificity of 99.7%.
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