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. 2024 Jul 31;9(10):2996-3005.
doi: 10.1016/j.ekir.2024.07.025. eCollection 2024 Oct.

Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units

Matthew T James  1   2   3   4 , Elijah Dixon  2   5 , Zhi Tan  1 , Pamela Mathura  6   7 , Indraneel Datta  5 , Rohan N Lall  5 , Jennifer Landry  1 , Evan P Minty  1 , Gregory A Samis  5 , Gerald B Winkelaar  8 , Neesh Pannu  6
Affiliations

Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units

Matthew T James et al. Kidney Int Rep. .

Abstract

Introduction: Acute kidney injury (AKI) is common in the perioperative setting and associated with poor outcomes. Whether clinical decision support improves early management and outcomes of AKI on surgical units is uncertain.

Methods: In this cluster-randomized, stepped-wedge trial, 8 surgical units in Alberta, Canada were randomized to various start dates to receive an education and clinical decision support intervention for recognition and early management of AKI. Eligible patients were aged ≥18 years, receiving care on a surgical unit, not already receiving dialysis, and with AKI.

Results: There were 2135 admissions of 2038 patients who met the inclusion criteria; mean (SD) age was 64.3 (16.2) years, and 885 (41.4%) were females. The proportion of patients who experienced the composite primary outcome of progression of AKI to a higher stage, receipt of dialysis, or death was 16.0% (178 events/1113 admissions) in the intervention group; and 17.5% (179 events/1022 admissions) in the control group (time-adjusted odds ratio, 0.76; 95% confidence interval [CI], 0.53-1.08; P = 0.12). There were no significant differences between groups in process of care outcomes within 48 hours of AKI onset, including administration of i.v. fluids, or withdrawal of medications affecting kidney function. Both groups experienced similar lengths of stay in hospital after AKI and change in estimated glomerular filtration rate (eGFR) at 3 months.

Conclusion: An education and clinical decision support intervention did not significantly improve processes of care or reduce progression of AKI, length of hospital stays, or recovery of kidney function in patients with AKI on surgical units.

Keywords: acute kidney injury; clinical decision support; cluster randomized trial.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Cohort formation. AKI, Acute kidney injury.
Figure 2
Figure 2
Subgroup analyses for effect of the intervention on the primary outcome of AKI progression and the composite process of care outcome. AKI, Acute kidney injury.
See this image and copyright information in PMC

References

    1. Borthwick E., Ferguson A. Perioperative acute kidney injury: risk factors, recognition, management, and outcomes. BMJ. 2010;341 doi: 10.1136/bmj.c3365. - DOI - PubMed
    1. James M.T., Dixon E., Roberts D.J., et al. Improving prevention, early recognition and management of acute kidney injury after major surgery: results of a planning meeting with multidisciplinary stakeholders. Can J Kidney Health Dis. 2014;1:20. doi: 10.1186/s40697-014-0020-y. - DOI - PMC - PubMed
    1. Grams M.E., Sang Y., Coresh J., et al. Acute kidney injury after major surgery: A retrospective analysis of Veterans Health Administration data. Am J Kidney Dis. 2016;67:872–880. doi: 10.1053/j.ajkd.2015.07.022. - DOI - PMC - PubMed
    1. Chertow G.M., Burdick E., Honour M., Bonventre J.V., Bates D.W. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–3370. doi: 10.1681/ASN.2004090740. - DOI - PubMed
    1. Coca S.G., Peixoto A.J., Garg A.X., Krumholz H.M., Parikh C.R. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis. 2007;50:712–720. doi: 10.1053/j.ajkd.2007.07.018. - DOI - PubMed

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