Automated, medication-targeted alerts for Acute Kidney Injury – A randomized trial

Acute kidney injury is common among hospitalized individuals, particularly
those exposed to certain medications, and is associated with substantial
morbidity and mortality. In a pragmatic, open-label, parallel group
randomized controlled trial (clinicaltrials.gov NCT02771977), we
investigate whether an automated clinical decision support system affects
discontinuation rates of potentially nephrotoxic medications and improves
outcomes in patients with AKI. Participants included 5,060 hospitalized
adults with AKI and an active order for any of three classes of
medications of interest: non-steroidal anti-inflammatory drugs,
renin-angiotensin-aldosterone system inhibitors, or proton pump
inhibitors. Within 24 hours of randomization, a medication of interest was
discontinued in 61.1% of the alert group versus 55.9% of the usual care
group (relative risk 1.08, 1.04–1.14, p=0.0003). The primary outcome – a
composite of progression of acute kidney injury, dialysis, or death –
occurred in 585 (23.1%) individuals in the alert group and 639 (25.3%)
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 proton pump inhibitors but not non-steroidal
anti-inflammatory drug or renin-angiotensin system inhibitor.