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Abstract: FR-PO068

Electronic Alert Outpatient Protocol Improves the Quality of Care for the Risk of Postcontrast AKI Following Computed Tomography

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Park, Seokwoo, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Kwon, Eun-Jeong, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
Background

Prevention and diagnosis of postcontrast acute kidney injury (PCAKI) after contrast-enhanced computed tomography (CECT) requires intravenous fluid administration and follow-up measurements of serum creatinine in high-risk patients, which is often burdensome in outpatient department. Here, we investigated whether an electronic alert system can promote quality improvement regarding prevention and timely diagnosis of PCAKI, and long-term outcomes.

Methods

In March 2018, we launched an automated alert system incorporated with hospital information system in a tertiary hospital in South Korea. The system identifies patients with baseline renal dysfunction, provides with protocolized prescription of fluid regimen, and recommends follow-up serum creatinine measurement. Severe PCAKI was defined as increase in serum creatinine from baseline of more than 50%.
Participants were categorized according to the time period when CECT was prescribed, before and after the launch of the system. Propensity for the surveillance of PCAKI with serum creatinine measurement, severity of PCAKI, and admission within 6 months were compared using logistic regression. Risks of mortality and renal replacement therapy were analyzed with Cox regression.

Results

Historical and alert group included 289 and 309 participants, respectively. After the introduction of alert system, participants were more likely to be followed for the surveillance of PCAKI (66.7% versus 29.4%; ORadj, 5.37; P<.001). Within those followed-up, severe PCAKI was less common in alert group (5.3% versus 10.6%; ORadj, 0.31; P=0.051), albeit not statistically significant. The two groups did not differ in terms of admission (Padj=0.597), mortality (Padj=0.589), and renal replacement therapy (Padj=0.434).

Conclusion

An automated alert system can assist in appropriate prevention and reduce underdiagnosis of PCAKI, concomitantly limiting clinical burdens of care providers. Whether the system may improve long-term outcomes is yet uncertain.

Study protocol

Funding

  • Government Support – Non-U.S.