Kidney Week

Abstract: TH-PO1167

Acute Kidney Disease Detection in an Outpatient Setting: A Pragmatic Randomized Controlled Trial

Session Information

• Late-Breaking Science Posters
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Chang, David R., China Medical University Hospital Department of Internal Medicine, Taichung, Taiwan

David R. Chang, MD

• Chiang, Hsiu-Yin, China Medical University Hospital, Taichung, Taiwan

Hsiu-Yin Chiang, MS, PhD

• Lin, Yu-Ting, China Medical University Hospital, Taichung, Taiwan

Yu-Ting Lin, PhD

• Lin, Zi-Han, China Medical University Hospital, Taichung, Taiwan

Zi-Han Lin, MS

• Yeh, Hung chieh, China Medical University Hospital Department of Internal Medicine, Taichung, Taiwan

Hung chieh Yeh, MD

• Kuo, Chin-Chi, China Medical University Hospital, Taichung, Taiwan

Chin-Chi Kuo, MD, PhD, MPH

Background

Outpatient acute kidney injury or disease (AKD_OPT) is underrecognized due to fragmented data. No randomized controlled trials (RCTs) of AKD_OPT alert system have been reported.

Methods

Taiwan's National Health Insurance MediCloud enables integration of serum creatinine (S-Cre) data across institutions within 180 days before a visit. We developed an AKI Detection System (AKIDS) to screen for AKD_OPT and suggest nephrology referrals (Fig 1). This pragmatic RCT assessed AKIDS's effectiveness in reducing the 1-year risk of composite kidney outcome (CKO) — including ESKD, S-Cre doubling, and a 40% eGFR decline — in cancer-free adult outpatients. CKO risks were estimated using Cox proportional hazard models.

Results

Among 9,907 AKD_OPT patients, the adjusted hazard ratio (aHR) for 1-year CKO with AKIDS was 0.91 (95% CI: 0.81, 1.03), with an adjusted absolute risk reduction (aARR) of 11 per 1,000 patients (95% CI: 10, 13). Among 213 high-risk patients who adhered to nephrology follow-up in 3 months, AKIDS was associated with a 39% reduced risk of 1-year CKO (0.61; 95% CI: 0.42, 0.89) and an aARR of 160 per 1,000 patients (95% CI: 122, 198), with a number needed to treat of 6 (95% CI: 5, 8). The AKIDS’s time-to-event curve for 1-year CKO was consistently lower (Fig 2).

Conclusion

This RCT demonstrates the effectiveness and resource efficiency of AKIDS in AKD_OPT care by targeting high-risk outpatients for nephrology referral. Studies are needed to evaluate its generalizability in healthcare systems with varying levels of data interoperability.

Funding

• Government Support - Non-U.S.