Data from: Early, individualized recommendations for hospitalized patients with acute kidney injury: A randomized clinical trial

Importance: Acute kidney injury (AKI) is a common complication during
hospitalization associated with poor outcomes. Objective: To evaluate
whether diagnostic and therapeutic recommendations sent from a Kidney
Action Team through the electronic health record improve outcomes among
patients hospitalized with AKI, compared to usual care.  Design,
Setting, participants: Randomized, clinical trial conducted at two US
health systems including seven hospitals.  Hospitalized patients
with AKI were randomized between October 29th, 2021, to February 8th,
2024. Final follow-up occurred in February 2024. Intervention: An alert
was sent to the Kidney Action Team, consisting of a physician and
pharmacist (never directly to the clinical providers) who provided
personalized recommendations for patients with AKI in five major
categories (general diagnostics, volume, potassium, acid-base, and
medications) within 1 hour via a structured note in the electronic health
record. The note is immediately visible to anyone who has access to the
chart. Randomization to the intervention or usual care occurred after the
note was generated, but the note was only delivered to clinicians of
patients randomized to the intervention group. Main Outcomes and Measures:
The primary outcome was a composite outcome consisting of AKI progression
to a higher stage of AKI, dialysis, or mortality occurring while the
patient remained hospitalized but within 14 days from
randomization.  Results: 4,003 patients (median age 72 (61-81)
years; 1874 (47%) female; 931 (23%) Black were randomized.  The
KAT made 14,539 recommendations, with a median (IQR) of 3 (2-5) per
patient.  The primary outcome occurred in 19.8% of the
intervention group and in 18.4% in the usual care group (difference: 1.4%,
95% CI: -1.1, 3.8, P=0.28).  Of six secondary outcomes, only
rates of recommendation implementation significantly differed between the
two groups:  2459/7270 (33.8%) of recommendations were
implemented in the intervention group, and 1766/7269 (24.3%) of the
(undelivered) recommendations were implemented in the usual care group
within 24 hours (difference: 9.5%, 95% CI 8.1%, 11.0%, p<0.001).
Conclusions and Relevance: Among patients hospitalized with AKI,
recommendations from a Kidney Action Team did not significantly reduce the
composite outcome of worsening AKI stage, dialysis, or mortality, despite
a higher rate of recommendation implementation in the intervention group,
compared to usual care.  Trial Registration: NCT04040296
(https://clinicaltrials.gov/study/NCT04040296)