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Acute kidney injury risk-based screening in pediatric inpatients: a pragmatic randomized trial.

ABSTRACT: BACKGROUND:Pediatric acute kidney injury (AKI) is common and associated with increased morbidity, mortality, and length of stay. We performed a pragmatic randomized trial testing the hypothesis that AKI risk alerts increase AKI screening. METHODS:All intensive care and ward admissions of children aged 28 days through 21 years without chronic kidney disease from 12/6/2016 to 11/1/2017 were included. The intervention alert displayed if calculated AKI risk was?>?50% and no serum creatinine (SCr) was ordered within 24?h. The primary outcome was SCr testing within 48?h of AKI risk?>?50%. RESULTS:Among intensive care admissions, 973/1909 (51%) were randomized to the intervention. Among those at risk, more SCr tests were ordered for the intervention group than for controls (418/606, 69% vs. 361/597, 60%, p?=?0.002). AKI incidence and severity were the same in intervention and control groups. Among ward admissions, 5492/10997 (50%) were randomized to the intervention, and there were no differences between groups in SCr testing, AKI incidence, or severity of AKI. CONCLUSIONS:Alerts based on real-time prediction of AKI risk increased screening rates in intensive care but not pediatric ward settings. Pragmatic clinical trials provide the opportunity to assess clinical decision support and potentially eliminate ineffective alerts.

SUBMITTER: Van Driest SL

PROVIDER: S-EPMC6962531 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Acute kidney injury risk-based screening in pediatric inpatients: a pragmatic randomized trial.

Van Driest Sara L SL Wang Li L McLemore Michael F MF Bridges Brian C BC Fleming Geoffrey M GM McGregor Tracy L TL Jones Deborah P DP Shirey-Rice Jana J Gatto Cheryl L CL Gay James C JC Byrne Daniel W DW Weitkamp Asli A Roden Dan M DM Bernard Gordon G

Pediatric research 20190827 1

<h4>Background</h4>Pediatric acute kidney injury (AKI) is common and associated with increased morbidity, mortality, and length of stay. We performed a pragmatic randomized trial testing the hypothesis that AKI risk alerts increase AKI screening.<h4>Methods</h4>All intensive care and ward admissions of children aged 28 days through 21 years without chronic kidney disease from 12/6/2016 to 11/1/2017 were included. The intervention alert displayed if calculated AKI risk was > 50% and no serum crea ...[more]

PMID: 31454829

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Project description:BackgroundInnovative care models are needed to address gaps in kidney care follow-up among acute kidney injury (AKI) survivors. We developed the multidisciplinary AKI in Care Transitions (ACT) program, which embeds post-AKI care in patients' primary care clinic.ObjectiveThe objective of this randomized pilot trial is to test the feasibility and acceptability of the ACT program and study protocol, including recruitment and retention, procedures, and outcome measures.MethodsThe study will be conducted at Mayo Clinic in Rochester, Minnesota, a tertiary care center with a local primary care practice. Individuals who are included have stage 3 AKI during their hospitalization, do not require dialysis at discharge, have a local primary care provider, and are discharged to their home. Patients unable or unwilling to provide informed consent and recipients of any transplant within 100 days of enrollment are excluded. Consented patients are randomized to receive the intervention (ie, ACT program) or usual care. The ACT program intervention includes predischarge kidney health education from nurses and coordinated postdischarge laboratory monitoring (serum creatinine and urine protein assessment) and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no specific study-related intervention, and any aspects of AKI care are at the direction of the treating team. This study will examine the feasibility of the ACT program, including recruitment, randomization and retention in a trial setting, and intervention fidelity. The feasibility and acceptability of participating in the ACT program will also be examined in qualitative interviews with patients and staff and through surveys. Qualitative interviews will be deductively and inductively coded and themes compared across data types. Observations of clinical encounters will be examined for discussion and care plans related to kidney health. Descriptive analyses will summarize quantitative measures of the feasibility and acceptability of ACT. Participants' knowledge about kidney health, quality of life, and process outcomes (eg, type and timing of laboratory assessments) will be described for both groups. Clinical outcomes (eg, unplanned rehospitalization) up to 12 months will be compared with Cox proportional hazards models.ResultsThis study received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups.ConclusionsFeasible and generalizable AKI survivor care delivery models are needed to improve care processes and health outcomes. This pilot trial will test the ACT program, which uses a multidisciplinary model focused on primary care to address this gap.Trial registrationClinicalTrials.gov NCT05184894; https://www.clinicaltrials.gov/ct2/show/NCT05184894.International registered report identifier (irrid)DERR1-10.2196/48109.

Dataset Information

Acute kidney injury risk-based screening in pediatric inpatients: a pragmatic randomized trial.

Publications

Acute kidney injury risk-based screening in pediatric inpatients: a pragmatic randomized trial.

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