Acute Kidney Injury Electronic alerts in Primary Care - Findings from a large population cohort.

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Acute Kidney Injury Electronic alerts in Primary Care - Findings from a large population cohort.

QJM. 2017 Apr 11;:

Authors: Holmes J, Allen N, Roberts G, Geen J, Williams JD, Phillips AO, Welsh AKI steering group

Abstract
Background: Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.
Aims: We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
Design: A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
Method: The study utilised the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
Results: 28.8% of the 22,723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalisation was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within seven days, 42.5% between seven and ninety days, and 8.4% was not repeated within ninety days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
Conclusion: The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within seven days should be considered an appropriate response to AKI e-alerts in primary care.

PMID: 28402560 [PubMed - as supplied by publisher]

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