In-Hospital e-Alerts: A Step Toward Better Kidney Health?

TOPLINE:

Electronic alerts (e-alerts) for acute kidney injury (AKI) for hospitalized patients are linked to a lower risk for AKI progression, increased consultations with nephrologists, and post-AKI reduced use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not with reduced mortality.

METHODOLOGY:

• AKI is a common complication in hospitalized patients, leading to increased comorbidities, healthcare costs, and short- and long-term mortality, but the impact of early detection through electronic health care record systems (e-alerts) is unclear.
• Researchers conducted an updated systematic review and meta-analysis to assess the association of e-alerts for AKI with patient outcomes and clinical practice patterns.
• Overall, 13 studies involving 41,837 patients with AKI were included, comparing e-alerts for AKI with standard care or no e-alerts.
• The primary outcomes were mortality, AKI progression, dialysis events, and kidney recovery, and secondary outcomes were nephrologist consultations, post-AKI exposure to NSAIDs and other medications, and hospital length of stay and costs.
• The investigators assessed bias, the certainty of evidence, and whether the primary outcome conclusions of the meta-analysis were premature.

TAKEAWAY:

• The use of e-alerts for AKI was not associated with reduced mortality outcomes compared with no e-alerts (risk ratio [RR], 0.96; 95% CI, 0.89-1.03; 12 studies).
• E-alerts were associated with a reduced risk for AKI progression (RR, 0.91; 95% CI, 0.84-0.99; five studies); however, the results were found to be heterogeneous and possibly premature.
• E-alerts for AKI were also linked to increased nephrologist consultations (RR, 1.45; 95% CI, 1.04-2.02; 11 studies), reduced post-AKI NSAID exposure (RR, 0.75; 95% CI, 0.59-0.95; four studies), and improved AKI documentation (RR, 1.28; 95% CI, 1.04-1.58; eight studies).
• The use of e-alerts for AKI was associated with increased dialysis events (RR, 1.16; 95% CI, 1.05-1.28).

IN PRACTICE:

“We recommend that each hospital establish its own AKI e-alert system and individualized AKI management protocol tailored to its specific needs,” wrote the authors who also suggested the system be “integrated with earlier risk stratification methods, such as the renal angina index, artificial intelligence–based continuous AKI prediction, and care bundle implementation within a clinical decision support system to enhance early diagnosis and management, potentially improving outcomes.”

SOURCE:

This study was led by Jia-Jin Chen, MD, from the Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan. It was published online in JAMA Network Open.

LIMITATIONS:

The limitations included the scarcity of randomized clinical trials in the meta-analysis. Few studies examined the impact of these e-alerts on the hospital length of stay, healthcare costs, AKI stage progression, and post-AKI kidney recovery, which limited the ability to draw conclusive statements on these aspects. Major adverse kidney events at 28 and 90 days were not reported in any of the enrolled studies, so the impact of AKI e-alerts and increased dialysis events on long-term outcomes remained uncertain.

DISCLOSURES:

The study was supported by grants from the Taiwanese Ministry of Health and Welfare and Linkou Chang Gung Memorial Hospital. The authors declared no conflicts of interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.