Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement.

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Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study Sehoon Park, Seon Ha Baek, Soyeon Ahn, Kee-Hyuk Lee, Hee Hwang, Jiwon Ryu, Shin Young Ahn, Ho Jun Chin, Ki Young Na, Dong- Wan Chae, Sejoong Kim American Journal of Kidney Diseases Volume 71, Issue 1, Pages 9-19 (January 2018) DOI: 10.1053/j.ajkd.2017.06.008 Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Flow chart of the study population. Abbreviations: AKI, acute kidney injury; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; Scr, serum creatinine. American Journal of Kidney Diseases 2018 71, 9-19DOI: (10.1053/j.ajkd.2017.06.008) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Adjusted survival curves from Cox proportional hazard models show acute kidney injury (AKI) recovery in the study population. Solid line indicates the adjusted survival curve of the alert group, and dashed line indicates the survival curve of the usual-care group. The x-axis shows days from the AKI event, and the y-axis shows adjusted cumulative incidence. The Cox proportional hazard model was adjusted for age (categorical, <50, 50-70, and >70 years); sex; baseline eGFR (categorical, <30, 30-60, and >60mL/min/1.73m2); admitting department (categorical, surgical, and nonsurgical); whether the AKI was identified as community acquired; history of cancer, hypertension, diabetes mellitus, ischemic heart disease, or heart failure; use of diuretics, nonsteroidal anti-inflammatory drugs, or renin angiotensin aldosterone system blockers; and AKI stage (1, 2, and 3). The overlooked AKI cases were not included. American Journal of Kidney Diseases 2018 71, 9-19DOI: (10.1053/j.ajkd.2017.06.008) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 The impact of introduction of the acute kidney injury (AKI) alert system on AKI recovery within 30 days in the various subgroups. Boxes indicate hazard ratio (HR), and horizontal gray lines crossing the boxes indicate 95% confidence interval (CI). The Cox proportional hazard model was adjusted for age (categorical, <50, 50-70, and >70 years); sex; baseline estimated glomerular filtration rate (eGFR; categorical, <30, 30-60, and >60mL/min/1.73m2); admitting department (categorical, surgical vs nonsurgical); whether the AKI was identified as community acquired; history of cancer, hypertension, diabetes mellitus, ischemic heart disease, or heart failure; use of diuretics, nonsteroidal anti-inflammatory drugs, or renin angiotensin aldosterone system blockers; and AKI stage (1, 2, and 3). The overlooked AKI cases were not considered. American Journal of Kidney Diseases 2018 71, 9-19DOI: (10.1053/j.ajkd.2017.06.008) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Risk factors for 30-day patient mortality in the study population. The impact of each characteristic on 30-day patient mortality is shown in the forest plot. Boxes indicate hazard ratio (HR) of characteristics, and horizontal gray lines crossing the boxes indicate 95% confidence interval (CI). The Cox proportional hazard model was adjusted for age (categorical, <50, 50-70, and >70 years); sex; baseline estimated glomerular filtration rate (eGFR; categorical, <30, 30-60, and >60mL/min/1.73m2); admitting department (categorical, surgical vs nonsurgical); whether the acute kidney injury (AKI) was identified as community acquired; history of cancer, hypertension, diabetes mellitus, ischemic heart disease, or heart failure; use of diuretics, nonsteroidal anti-inflammatory drugs, or renin angiotensin aldosterone system blockers; and AKI stage (1, 2, and 3). American Journal of Kidney Diseases 2018 71, 9-19DOI: (10.1053/j.ajkd.2017.06.008) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions