Multi-Hospital Electronic Decision Support for Drug-Associated AKI

This project, “Multi-Hospital Electronic Decision Support for Drug-Associated AKI” (MEnD-AKI), assesses the effectiveness of a clinical surveillance system augmented with real-time predictive analytics to support a pharmacist-led intervention to reduce the progression and complications of Drug-Associated Acute Kidney Injury (D-AKI). We are studying the effect of an advanced clinical decision support system for primary physicians and hospitalists focused on reducing D-AKI in hospitalized (non-ICU) adults.

Why is it important to address drug-associated AKI?

Overall incidence of AKI is increasing, especially in hospitalized patients and those undergoing surgery. In the United States over an eight-year period, the occurrence of AKI increased by 38% with a similar increase in dialysis rates. Among the many factors likely contributing to this rise in AKI rates are an aging population, increased chronic and comorbid illnesses, and a greater use of nephrotoxic medications and imaging agents. Drugs are a leading contributor to AKI, as up to 60% of AKI cases in hospitalized patients are related to nephrotoxins. The number of nephrotoxins received directly relates to length of hospital stay.

Furthermore, D-AKI is associated with severe outcomes, with 70% of patients having evidence of residual kidney damage following the initial D-AKI event. The dialysis dependence rates and/or mortality rates for D-AKI are similar to those of AKI from other etiologies. We have determined that patients with high risk for AKI are identified late and often continue to receive nephrotoxic agents until AKI becomes severe. Specifically, one-third of potential adverse drug events (ADEs) in patients with AKI is due to continuation of a contraindicated nephrotoxin.

How could the MEnD-AKI project impact drug-associated AKI?

Our proposal is designed to address this unmet need of early and appropriate management of nephrotoxins in high-risk patients. In 2012, Kidney Disease Improving Global Outcomes (KDIGO) published the first comprehensive AKI clinical practice guideline. Recommendations include the use of standard criteria for defining and staging AKI and a series of stage-based management steps to be considered for all patients with AKI or at risk for developing it. Clinicians have been slow to adopt these recommendations, however, and some groups (most notably, the US KDOQI expert panel), while endorsing the guideline overall, have called for more research to test the recommendations.

The MEnD-AKI project addresses this concern by testing whether a unique clinical decision-support system identifying high-risk patients coupled with an advanced pharmacist service directed to the primary physician can address D-AKI and drug dosing for other forms of AKI to improve patient care. Thus, our central goal is to examine the effect of a pharmacist-led intervention on the early detection and management of AKI, progression of and short-term recovery from AKI, and on various AKI-related outcomes.

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