ELECTRONIC CREATININE ALERT SYSTEM. A FIRST STEP TOWARDS PREVENTING HOSPITAL ACQUIRED ACUTE KIDNEY INJURY

Background and Aims Acute kidney injury (AKI) is a common complication in the critically ill and non-critically ill patient. There is currently no specific treatment for patients who develop AKI, so early recognition may help prevent progression to more advanced stages and the need for kidney replacement therapies (KRT). Electronic Alert Systems (EAS) emerge as a useful tool in different clinical scenarios to alert the clinician to potentially harmful situations. One of the utilities of the EAS is the AKI scenario, in which the clinician can be alerted early to serum creatinine (SCr) changes in real time and thus establish early intervention protocols to avoid the poor outcomes described above. The aim of the present study is to analyze the incidence of AKI in a tertiary hospital using an EAS based on SCr changes (Electronic Creatinine Alert System -ECAS-). Method Retrospective study conducted in a tertiary referral hospital. All discharges of patients over 18 years of age, which were issued from 1 January 2019 to 31 December 2021, were analyzed. Exclusion criteria were: discharges from critical care units, patients admitted to the emergency room, patients with AKI criteria on admission, patients admitted to the nephrology department and patients with CKD G5 or on KRT. The ECAS was developed with the aim of alerting patients with and increase of ≥ 0.3mg/dL of SCr or an elevation of ≥ 1.5 times the baseline creatinine value, based on AKI SCr from the KDIGO guidelines. The aims of the present study were: 1. Number of hospitals discharges that activated the ECAS, as well as the severity of AKI; 2. Categorize the departments in which ECAS was common; and 3. Assessing length of hospital stay, survival and kidney recovery during admission defined as SCr less than 1.5 times baseline. Results A total of 69,002 discharges were analyzed over 3 years. Finally, 46,149 discharges were included in the analysis, of which 5,593 (13.5%) discharges activated the ECAS. The distribution by year in which the ECAS was activated was 1,788 (11,8%) of all discharges in 2019, 1,860 (12,4%) in 2020 and 1,945 (12,1%) in 2021. The median age was 75 years (65 – 83), 62% were male. The 5 departments with the highest number of ECAS activations were: Geriatric (14.2%), Cardiology (11.9%), General Surgery (9.9%), Infectious Diseases (9.2%) and Cardiac Surgery (7.6%). Baseline SCr was 1.12mg/dL (0.80-1,79), maximum SCr was 1.99mg/dL(1.40 - 3.19) and SCr at discharge was 1.39 (0.96 - 2.23). 69,7% of patients had AKI stage 1, 21,3% had AKI stage 2 and finally 9% had AKI stage 3. Length of hospital stay was significantly elevated in patients who activated the ECAS [6 days (3 - 11) vs. 13 (8 - 22); p: <0.001], the survival distributions for the ECAS activation were statistically different, X2 (2) = 5.522, p: 0.019. Finally, kidney recovery at discharge was significantly lower in AKI 2 (18.5%) and AKI 3 (8.5%) patients compared to AKI 1 patients (73%) (p: <0.001 for all). Conclusion The ECAS is a suitable electronic alert system that allows rapid identification of patients with AKI. The activation of ECAS is associated with poor outcomes. This study led to the adoption of a nephrology rapid response team for early detection of AKI before creatinine elevation using among others Point-of-care ultrasonography and acute kidney stress biomarkers.