Abstract: FR-OR63
Automated, Medication-Targeted Alerts on AKI Outcomes: A Multi-Center Randomized, Controlled Trial
Session Information
- High-Impact Clinical Trials
November 04, 2022 | Location: W415 Valencia, Orange County Convention Center‚ West Building
Abstract Time: 11:00 AM - 11:15 AM
Category: Acute Kidney Injury
- 102 AKI: Clinical‚ Outcomes‚ and Trials
Authors
- Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
- Yamamoto, Yu, Yale School of Medicine, New Haven, Connecticut, United States
- Martin, Melissa, Yale School of Medicine, New Haven, Connecticut, United States
- Ghazi, Lama, Yale School of Medicine, New Haven, Connecticut, United States
- Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
- Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
- Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States
- Greenberg, Jason Henry, Yale School of Medicine, New Haven, Connecticut, United States
- Ugwuowo, Ugochukwu Caleb, Yale School of Medicine, New Haven, Connecticut, United States
Background
Acute kidney injury (AKI) is common among hospitalized individuals, particularly those exposed to certain medications. Whether prompt detection of AKI with discontinuation of relevant medications improves clinical outcomes is unknown.
Methods
Pragmatic, open-label, parallel group, randomized controlled trial conducted from August 2020 to November 2021 at four hospitals in a large, regional US health system. Participants included hospitalized adults with AKI and an active order for any of three classes of MOIs: non-steroidal anti-inflammatory drugs (NSAID), renin-angiotensin-aldosterone system inhibitors (RAASi), or proton pump inhibitors (PPI). The intervention was an automated, electronic “pop-up” alert which appeared during medication order entry and flagged the MOIs for potential discontinuation. The primary outcome was a composite of progression of AKI, dialysis, or death within 14 days or hospital discharge.
Results
We enrolled 5,060 individuals over 15 months. The median (IQR) age was 70 (59 – 80) years, 48% were female and 19% self-described as Black. Within 24 hours of randomization, an MOI was discontinued in 61.1% of the alert group versus 55.9% of the usual care group (p=0.0003). The primary outcome occurred in 585 (23.1%) of individuals in the alert group and 639 (25.3%) of patients in the usual care group (RR 0.92, 0.83 – 1.01, p=0.09). The pre-specified subgroup analysis found a significant benefit of alerting among those exposed to PPI.
Conclusion
A medication-targeted AKI alert led to increased discontinuation of medications that may affect kidney function. While the overall impact on clinical outcomes was not statistically significant, the alert system led to significantly improved outcomes among those exposed to PPI.
Primary outcome rates
Funding
- NIDDK Support