26 μmol/l increase in creatinine within 48 hours) accounted for 9.6%. Rule 2 (≥50% increase in creatinine within previous 7 days) and rule 3 (≥50% creatinine increase from the median value of results within the last 8-365 days) accounted for 27.3% and 63.1%, respectively. Hospital-acquired AKI was predominantly identified by rules 1 and 2 (71.7%), and community-acquired AKI (86.3%) by rule 3. Stages 2 and 3 were detected by rules 2 and 3. Ninety-day mortality was higher in AKI rule 2 (32.4%) than rule 1 (28.3%, DISCUSSION: Rule 1 could only be invoked for stage 1 alerts and was associated with acute on chronic kidney disease acquired in hospital. Rule 2 was also associated with hospital-acquired AKI and had the highest mortality and nonrecovery. Rule 3 was the commonest cause of an alert and was associated with community-acquired AKI." />
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Holmes J, Roberts G, Meran S, et al. Understanding Electronic AKI Alerts: Characterization by Definitional Rules. Kidney Int Rep. 2016;2(3):342-349doi: 10.1016/j.ekir.2016.12.001.
Holmes, J., Roberts, G., Meran, S., Williams, J. D., Phillips, A. O. (2017). Understanding Electronic AKI Alerts: Characterization by Definitional Rules. Kidney international reports, 2(3), 342-349. https://doi.org/10.1016/j.ekir.2016.12.001
Holmes, Jennifer, et al. "Understanding Electronic AKI Alerts: Characterization by Definitional Rules." Kidney international reports vol. 2,3 (2017): 342-349. doi: https://doi.org/10.1016/j.ekir.2016.12.001
Holmes J, Roberts G, Meran S, Williams JD, Phillips AO. Understanding Electronic AKI Alerts: Characterization by Definitional Rules. Kidney Int Rep. 2016 Dec 09;2(3):342-349. doi: 10.1016/j.ekir.2016.12.001. eCollection 2017 May. PMID: 29142963; PMCID: PMC5678680.
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Kidney Int Rep. 2016 Dec 09;2(3):342-349. doi: 10.1016/j.ekir.2016.12.001. eCollection 2017 May.

Understanding Electronic AKI Alerts: Characterization by Definitional Rules.

Kidney international reports

Jennifer Holmes, Gethin Roberts, Soma Meran, John D Williams, Aled O Phillips,

Affiliations

  1. Welsh Renal Clinical Network, Cwm Taf University Health Board, Caerphilly, UK.
  2. Department of Clinical Biochemistry, Hywel Dda University Health Board, Aberystwyth, UK.
  3. Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.

PMID: 29142963 PMCID: PMC5678680 DOI: 10.1016/j.ekir.2016.12.001

Abstract

INTRODUCTION: Automated acute kidney injury (AKI) electronic alerts are based on comparing creatinine with historic results.

METHODS: We report the significance of AKI defined by 3 "rules" differing in the time period from which the baseline creatinine is obtained, and AKI with creatinine within the normal range.

RESULTS: A total of 47,090 incident episodes of AKI occurred between November 2013 and April 2016. Rule 1 (>26 μmol/l increase in creatinine within 48 hours) accounted for 9.6%. Rule 2 (≥50% increase in creatinine within previous 7 days) and rule 3 (≥50% creatinine increase from the median value of results within the last 8-365 days) accounted for 27.3% and 63.1%, respectively. Hospital-acquired AKI was predominantly identified by rules 1 and 2 (71.7%), and community-acquired AKI (86.3%) by rule 3. Stages 2 and 3 were detected by rules 2 and 3. Ninety-day mortality was higher in AKI rule 2 (32.4%) than rule 1 (28.3%,

DISCUSSION: Rule 1 could only be invoked for stage 1 alerts and was associated with acute on chronic kidney disease acquired in hospital. Rule 2 was also associated with hospital-acquired AKI and had the highest mortality and nonrecovery. Rule 3 was the commonest cause of an alert and was associated with community-acquired AKI.

Keywords: acute kidney injury; electronic alerts; outcome

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