PRevention of Acute Kidney Injury Initiated With Electronic Surveillance Enhancement
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease, Hospital |
| Therapuetic Areas: | Nephrology / Urology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/6/2019 |
| Start Date: | June 2012 |
| End Date: | December 2021 |
Electronic Surveillance Sniffer for Early Detection and Intervention for Acute Kidney Injury: PRAISE Trial
Introduction: Acute kidney injury (AKI) increases mortality, hospital cost, and rate of
progression toward end stage kidney disease 1-4. Early diagnosis and management of AKI is
known to improve the above mentioned outcomes.
Hypothesis: the investigators will design and validate an electronic surveillance tool to
screen all the ICU admissions for the earlier, more efficient diagnosis of AKI and as a
result improve the outcome of AKI in ICU patients.
Methods: the investigators plan to use the patient database, and AKIN (AKI network)
definition to design an electronic alert system to allow clinicians discover patients who
develop AKI. Then a randomized clinical trial will be conducted to compare earlier
intervention (based on Kidney Disease: Improving Global Outcomes [KDIGO] guidelines)
initiated by AKI sniffer alert to the conventional management provided by primary physician
in ICU.
progression toward end stage kidney disease 1-4. Early diagnosis and management of AKI is
known to improve the above mentioned outcomes.
Hypothesis: the investigators will design and validate an electronic surveillance tool to
screen all the ICU admissions for the earlier, more efficient diagnosis of AKI and as a
result improve the outcome of AKI in ICU patients.
Methods: the investigators plan to use the patient database, and AKIN (AKI network)
definition to design an electronic alert system to allow clinicians discover patients who
develop AKI. Then a randomized clinical trial will be conducted to compare earlier
intervention (based on Kidney Disease: Improving Global Outcomes [KDIGO] guidelines)
initiated by AKI sniffer alert to the conventional management provided by primary physician
in ICU.
A prospective controlled, unblinded clinical trial will be conducted among AKI patients who
are detected by the use of AKI sniffer. The investigators will randomize consecutive patients
who were detected to have AKI by AKI sniffer into two groups. In one group (control group),
patients will receive standard clinical care by the primary ICU physicians. The primary
physicians who take care of the control subjects will be kept blinded of the results of the
AKI sniffer. All the ICU physicians will receive a copy of KDIGO (March 2012) guidelines for
management of AKI prior to the initiation of the patient accrual. In the intervention group,
the research team will inform the primary care team about the occurrence of the AKI and
provides a copy of KDIGO guidelines for management of AKI to the clinicians. Each subject
will be followed until hospital discharge or for a maximum of 3 months, for clinical and
laboratory data including peak serum creatinine, creatinine at the end of follow up, peak
AKIN stage, along with other secondary outcomes. The investigators will exclude the prevalent
cases (AKI patients who have had AKI documented in their medical records by clinicians prior
to the ICU admission).
are detected by the use of AKI sniffer. The investigators will randomize consecutive patients
who were detected to have AKI by AKI sniffer into two groups. In one group (control group),
patients will receive standard clinical care by the primary ICU physicians. The primary
physicians who take care of the control subjects will be kept blinded of the results of the
AKI sniffer. All the ICU physicians will receive a copy of KDIGO (March 2012) guidelines for
management of AKI prior to the initiation of the patient accrual. In the intervention group,
the research team will inform the primary care team about the occurrence of the AKI and
provides a copy of KDIGO guidelines for management of AKI to the clinicians. Each subject
will be followed until hospital discharge or for a maximum of 3 months, for clinical and
laboratory data including peak serum creatinine, creatinine at the end of follow up, peak
AKIN stage, along with other secondary outcomes. The investigators will exclude the prevalent
cases (AKI patients who have had AKI documented in their medical records by clinicians prior
to the ICU admission).
Inclusion Criteria:
- All patients who are admitted in adult ICUs in Mayo Clinic Rochester
- Foley catheter for hourly UOP measurement
Exclusion Criteria:
- Prisoners
- Patients less than 18 years old.
- Lack of research authorization (in control group)
- ESRD on dialysis or s/p kidney transplantation
- Known AKI before admission to ICU
- Moribund patients
- Prevalent AKI admission in ICU (patients who have diagnosis of AKI documented in their
medical records prior to ICU admission)
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