ArticleKidney medicine2026
Shifts in Acute Kidney Injury Trends Post-Alert System Implementation: A Retrospective Observational Cohort Study.
Article in Kidney medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Rationale & Objective: Acute kidney injury (AKI), a complex syndrome involving multiple organ systems, requires timely intervention to prevent adverse outcomes. Despite the promise of AKI alert systems in improving early detection and management, their long-term effectiveness remains unevaluated. This study aimed to investigate the sustained impact of an AKI alert system over a decade of implementation. Study Design: Retrospective observational cohort study. Setting & Participants: Conducted at a Korean tertiary hospital, analyzing 13,301 adult patients with AKI, from 246,650 admissions (2013-2023). Exposure: Introduction of an automated AKI alert system (implemented June 2014). Outcomes: Primary outcomes included 14-day AKI recovery, stage progression, dialysis onset, and mortality. Process outcomes comprised early nephrology consultation, overlooked AKI cases, and discontinuation of nephrotoxic medications. Long-term outcome was assessed as ≥35% estimated glomerular filtration rate (eGFR) decline within 3 years. Analytical Approach: Outcomes were compared across pre-alert (January 2013-May 2014), alert implementation (June 2014-December 2019), and pandemic (January 2020-December 2023) phases, using adjusted multivariable logistic analyses calculating unadjusted and covariate-adjusted odds ratios (ORs). Interrupted time series analysis evaluated temporal trends. Results: AKI recovery rates increased substantially in both alert implementation and pandemic phases (adjusted OR 2.40 [95% confidence interval (CI) 2.16-2.66] and 2.19 [1.94-2.47], respectively). Early nephrology consultation improved significantly (adjusted OR 3.33 [2.81-3.95] and 2.65 [2.20-3.19]), and overlooked AKI cases decreased (adjusted OR 0.49 [0.43-0.55] and 0.43 [0.36-0.51]). Long-term renal outcomes showed lower risk of significant eGFR decline during the implementation phase (adjusted OR 0.86 [0.76-0.99]). Interrupted time series analysis showed immediate improvements in recovery rates, early consultation rates, and overlooked AKI cases following alert implementation. Limitations: Single-center, retrospective design limits generalizability. Patient characteristic changes may confound results. Conclusions: The AKI alert system achieved sustained improvements in AKI recovery, early nephrology consultation, and AKI monitoring, over a decade, demonstrating long-term effectiveness despite evolving patient populations and health care environments.
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