Evidence map›Paper›PMID 25726515›Full record

Trial reportLancet (London, England)2015

Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial.

F Perry Wilson, Michael Shashaty, Jeffrey Testani, Iram Aqeel, Yuliya Borovskiy, Susan S Ellenberg, Harold I Feldman, Hilda Fernandez, Yevgeniy Gitelman, Jennie Lin and 5 more

4 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 175 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
175citing papers in PubMed, 17 pooled it
27.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01862419 nacompletednot on this map

An Electronic Alert System for In-Hospital Acute Kidney Injury: A Randomized, Controlled Trial

TypeinterventionalSponsorUniversity of PennsylvaniaRan2013 to 2014Enrolled2,393ConditionsAcute Kidney InjuryArmsAlert
NCT02753751 nacompletednot on this mapstarted 2018, after this paper: background citation

Optimizing Electronic Alerts for Acute Kidney Injury

TypeinterventionalSponsorYale UniversityRan2018 to 2020Enrolled6,030ConditionsAcute Kidney InjuryArmsAKI Alert
NCT03736304 nacompletednot on this mapstarted 2019, after this paper: background citation

The Effect of Automated Electronic Alert for Acute Kidney Injury on the Outcomes of Hospitalized Patients: a Single Center Randomized Controlled Trial.

TypeinterventionalSponsorThe First Affiliated Hospital with Nanjing Medical UniversityRan2019 to 2022Enrolled4,536ConditionsAcute Kidney Injury, Outcomes, Early DiagnosisArmsAKI alert, Usual care
NCT04040296 nacompletednot on this mapstarted 2021, after this paper: background citation

Personalized Recommendations for Acute Kidney Injury (AKI) Care Using a Kidney Action Team: A Randomized Trial

TypeinterventionalSponsorYale UniversityRan2021 to 2024Enrolled4,003ConditionsAcute Kidney InjuryArmsKidney Action Team Recommendations
3 · Its place in the literature

Who cites it

175 citing papers in PubMed, 17 syntheses or guidelines pooled it, 361 citations in OpenAlex.

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  11. Guideline
  12. eHealth interventions for people with chronic kidney disease.The Cochrane database of systematic reviews · 2019
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  15. Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2017
    Pooled it
  16. Electronic Alerts for Acute Kidney Injury.Deutsches Arzteblatt international · 2017
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115 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 1 country.

F Perry WilsonYale University School of Medicine, Program of Applied Translational Research, New Haven, CT, USA. Electronic address: francis.p.wilson@yale.edu.
Michael ShashatyDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Jeffrey TestaniYale University School of Medicine, Program of Applied Translational Research, New Haven, CT, USA.
Iram AqeelNephrology Associates, Teaneck, NJ, USA.
Yuliya BorovskiyDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Susan S EllenbergDepartment of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Harold I FeldmanDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Hilda FernandezColumbia University College of Physicians and Surgeons, New York, NY, USA.
Yevgeniy GitelmanDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Jennie LinDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Dan NegoianuDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Chirag R ParikhYale University School of Medicine, Program of Applied Translational Research, New Haven, CT, USA.
Peter P ReeseDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Richard UrbaniDepartment of Information Services, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Barry FuchsDepartment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
University of Pennsylvania · USYale University · USColumbia University · US

Funding

Training in Renal ResearchT32DK007006 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI HOLZMAN, LAWRENCE B. · 1986 to 2023
$8.5M
CLINICAL RESEARCH TRAINING IN KIDNEY DISEASET32DK007785 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI FELDMAN, HAROLD I · 2000 to 2019
$3.9M
Mediators & prognostic value of muscle mass & function in chronic kidney diseaseK23DK097201 · NIDDK · YALE UNIVERSITY · PI WILSON, FRANCIS PERRY · 2013 to 2017
$916k
Mentoring Program for Translational and Patient Oriented Research in AKIK24DK090203 · NIDDK · YALE UNIVERSITY · PI PARIKH, CHIRAG R · 2012 to 2016
$896k
Cardio-renal phenotype and prognosis in chronic heart failureK23HL114868 · NHLBI · YALE UNIVERSITY · PI TESTANI, JEFFREY M · 2012 to 2017
$845k
Acute Adipose Inflammation as a Contributor to Acute Kidney Injury After TraumaK23DK097307 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI SHASHATY, MICHAEL G. S. · 2013 to 2016
$626k
NHLBI NIH HHS K23 HL114868NHLBI NIH HHS K23HL114868NHLBI NIH HHS L30 HL115790NHLBI NIH HHS L30HL115790NIDDK NIH HHS K23 DK097201NIDDK NIH HHS K23DK097201NIDDK NIH HHS K23 DK097307NIDDK NIH HHS K24 DK090203NIDDK NIH HHS K24DK090203NIDDK NIH HHS T32 DK007006NIDDK NIH HHS T32DK007006
6 · The paper itself

Abstract

backgroundAcute kidney injury often goes unrecognised in its early stages when effective treatment options might be available. We aimed to determine whether an automated electronic alert for acute kidney injury would reduce the severity of such injury and improve clinical outcomes in patients in hospital.

methodsIn this investigator-masked, parallel-group, randomised controlled trial, patients were recruited from the hospital of the University of Pennsylvania in Philadelphia, PA, USA. Eligible participants were adults aged 18 years or older who were in hospital with stage 1 or greater acute kidney injury as defined by Kidney Disease Improving Global Outcomes creatinine-based criteria. Exclusion criteria were initial hospital creatinine 4·0 mg/dL (to convert to μmol/L, multiply by 88·4) or greater, fewer than two creatinine values measured, inability to determine the covering provider, admission to hospice or the observation unit, previous randomisation, or end-stage renal disease. Patients were randomly assigned (1:1) via a computer-generated sequence to receive an acute kidney injury alert (a text-based alert sent to the covering provider and unit pharmacist indicating new acute kidney injury) or usual care, stratified by medical versus surgical admission and intensive care unit versus non-intensive care unit location in blocks of 4-8 participants. The primary outcome was a composite of relative maximum change in creatinine, dialysis, and death at 7 days after randomisation. All analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01862419.

findingsBetween Sept 17, 2013, and April 14, 2014, 23,664 patients were screened. 1201 eligible participants were assigned to the acute kidney injury alert group and 1192 were assigned to the usual care group. Composite relative maximum change in creatinine, dialysis, and death at 7 days did not differ between the alert group and the usual care group (p=0·88), or within any of the four randomisation strata (all p>0·05). At 7 days after randomisation, median maximum relative change in creatinine concentrations was 0·0% (IQR 0·0-18·4) in the alert group and 0·6% (0·0-17·5) in the usual care group (p=0·81); 87 (7·2%) patients in the alert group and 70 (5·9%) patients in usual care group had received dialysis (odds ratio 1·25 [95% CI 0·90-1·74]; p=0·18); and 71 (5·9%) patients in the alert group and 61 (5·1%) patients in the usual care group had died (1·16 [0·81-1·68]; p=0·40).

interpretationAn electronic alert system for acute kidney injury did not improve clinical outcomes among patients in hospital.

fundingPenn Center for Healthcare Improvement and Patient Safety.

Indexed as

Electronic Health RecordsAcute Kidney InjuryAdultAgedAutomationBiomarkersCell PhoneCreatinineEarly DiagnosisFemaleHospitalizationHumansMaleMiddle AgedPrognosisSingle-Blind MethodBiomarkersCreatinine

Identifiers

PMID25726515
PMCPMC4475457
OpenAlexW2142336103

What OpenQuestion holds

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LicenceTDM
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.