Acute kidney injury electronic alerts in primary care - findings from a large population cohort
Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described. We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts. A prospec...
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| Veröffentlicht in: | QJM : An International Journal of Medicine 2017-09, Vol.110 (9), p.577-582 |
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| creator | Holmes, J Allen, N Roberts, G Geen, J Williams, J D Phillips, A O |
| description | Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.
We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care. |
| doi_str_mv | 10.1093/qjmed/hcx080 |
| format | Article |
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We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.</description><identifier>ISSN: 1460-2725</identifier><identifier>EISSN: 1460-2393</identifier><identifier>DOI: 10.1093/qjmed/hcx080</identifier><identifier>PMID: 28402560</identifier><language>eng</language><publisher>England</publisher><subject>Acute Kidney Injury - diagnosis ; Acute Kidney Injury - mortality ; Aged ; Clinical Laboratory Information Systems - organization & administration ; Disease Progression ; Female ; Humans ; Kidney Function Tests - methods ; Male ; Medical Records Systems, Computerized - statistics & numerical data ; Middle Aged ; Monitoring, Physiologic - methods ; Primary Health Care - methods ; Primary Health Care - standards ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - physiopathology ; Telemedicine - methods ; United Kingdom</subject><ispartof>QJM : An International Journal of Medicine, 2017-09, Vol.110 (9), p.577-582</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c329t-33b73e24c8c3565b41835ae2128552da4bbe502f7cb6ea61eb3a7fc098f2fa753</citedby><cites>FETCH-LOGICAL-c329t-33b73e24c8c3565b41835ae2128552da4bbe502f7cb6ea61eb3a7fc098f2fa753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28402560$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holmes, J</creatorcontrib><creatorcontrib>Allen, N</creatorcontrib><creatorcontrib>Roberts, G</creatorcontrib><creatorcontrib>Geen, J</creatorcontrib><creatorcontrib>Williams, J D</creatorcontrib><creatorcontrib>Phillips, A O</creatorcontrib><creatorcontrib>Welsh AKI Steering Group</creatorcontrib><creatorcontrib>on behalf of the Welsh AKI Steering Group</creatorcontrib><title>Acute kidney injury electronic alerts in primary care - findings from a large population cohort</title><title>QJM : An International Journal of Medicine</title><addtitle>QJM</addtitle><description>Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.
We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.</description><subject>Acute Kidney Injury - diagnosis</subject><subject>Acute Kidney Injury - mortality</subject><subject>Aged</subject><subject>Clinical Laboratory Information Systems - organization & administration</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Function Tests - methods</subject><subject>Male</subject><subject>Medical Records Systems, Computerized - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic - methods</subject><subject>Primary Health Care - methods</subject><subject>Primary Health Care - standards</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Telemedicine - methods</subject><subject>United Kingdom</subject><issn>1460-2725</issn><issn>1460-2393</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kD1PwzAQhi0EoqWwMSOPDIT6I46dsar4kiqxwGw5zqV1SeLUTiT670lpO93p3kevdA9C95Q8U5Lz-W7bQDnf2F-iyAWa0jQjCeM5vzzvkokJuolxSwhJZaqu0YSplDCRkSnSCzv0gH9c2cIeu3Y7hD2GGmwffOssNjWEPo4B7oJrzBhaEwAnuHJt6dp1xFXwDTa4NmENuPPdUJve-RZbv_Ghv0VXlakj3J3mDH2_vnwt35PV59vHcrFKLGd5n3BeSA4stcpykYkipYoLA4wyJQQrTVoUIAirpC0yMBmFghtZWZKrilVGCj5Dj8feLvjdALHXjYsW6tq04IeoqVKSjA2SjOjTEbXBxxig0qfXNCX6oFT_K9VHpSP-cGoeisP5DJ8d8j-d6XR0</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Holmes, J</creator><creator>Allen, N</creator><creator>Roberts, G</creator><creator>Geen, J</creator><creator>Williams, J D</creator><creator>Phillips, A O</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Acute kidney injury electronic alerts in primary care - findings from a large population cohort</title><author>Holmes, J ; Allen, N ; Roberts, G ; Geen, J ; Williams, J D ; Phillips, A O</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c329t-33b73e24c8c3565b41835ae2128552da4bbe502f7cb6ea61eb3a7fc098f2fa753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute Kidney Injury - diagnosis</topic><topic>Acute Kidney Injury - mortality</topic><topic>Aged</topic><topic>Clinical Laboratory Information Systems - organization & administration</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney Function Tests - methods</topic><topic>Male</topic><topic>Medical Records Systems, Computerized - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic - methods</topic><topic>Primary Health Care - methods</topic><topic>Primary Health Care - standards</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Telemedicine - methods</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holmes, J</creatorcontrib><creatorcontrib>Allen, N</creatorcontrib><creatorcontrib>Roberts, G</creatorcontrib><creatorcontrib>Geen, J</creatorcontrib><creatorcontrib>Williams, J D</creatorcontrib><creatorcontrib>Phillips, A O</creatorcontrib><creatorcontrib>Welsh AKI Steering Group</creatorcontrib><creatorcontrib>on behalf of the Welsh AKI Steering Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>QJM : An International Journal of Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holmes, J</au><au>Allen, N</au><au>Roberts, G</au><au>Geen, J</au><au>Williams, J D</au><au>Phillips, A O</au><aucorp>Welsh AKI Steering Group</aucorp><aucorp>on behalf of the Welsh AKI Steering Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute kidney injury electronic alerts in primary care - findings from a large population cohort</atitle><jtitle>QJM : An International Journal of Medicine</jtitle><addtitle>QJM</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>110</volume><issue>9</issue><spage>577</spage><epage>582</epage><pages>577-582</pages><issn>1460-2725</issn><eissn>1460-2393</eissn><abstract>Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.
We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.</abstract><cop>England</cop><pmid>28402560</pmid><doi>10.1093/qjmed/hcx080</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Acute Kidney Injury - diagnosis Acute Kidney Injury - mortality Aged Clinical Laboratory Information Systems - organization & administration Disease Progression Female Humans Kidney Function Tests - methods Male Medical Records Systems, Computerized - statistics & numerical data Middle Aged Monitoring, Physiologic - methods Primary Health Care - methods Primary Health Care - standards Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - physiopathology Telemedicine - methods United Kingdom |
| title | Acute kidney injury electronic alerts in primary care - findings from a large population cohort |
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