Project Summary
The overarching goal of this proposal is to determine whether rapid response-style, personalized
recommendations for the workup and treatment of patients with Acute Kidney Injury (AKI), as delivered by a
remote Kidney Action Team, will improve clinical outcomes in a hospitalized population. AKI is a common
complication in hospitalized patients and is associated with dramatic increases in the risk of inpatient mortality,
long-term chronic kidney disease, and cost. International guidelines for AKI treatment focus on best practices
that include appropriate management of drug dosing, avoidance of kidney-toxic exposures, and careful
hemodynamic and electrolyte balance. However, multiple studies and our preliminary data suggest that AKI is
often missed in a variety of hospital settings and that diagnostic and therapeutic actions are infrequently taken
or inappropriate. Failure to engage in best practices is associated with increased morbidity and mortality
among AKI patients.
Our group focuses extensively on increasing provider awareness and recognition of AKI. Our
randomized trials of simple electronic AKI alert systems have demonstrated clinical equipoise regarding the
effectiveness of such alerting, as there was no improvement in clinical outcomes among those in the alert
group. However, the alert was purely informational and provided no actionable recommendations. Because of
the heterogeneity of both the AKI patient and AKI etiology, diagnostic and treatment plans should be highly
individualized and consider many facets of care, including diagnostic workup, acid/base management,
electrolyte management, hemodynamic management, and medication management.
This proposal seeks to build on our prior experience to determine whether offering providers prompt
and actionable items that are personalized to individual patients may be more beneficial in the care of AKI
patients. Across two medical centers and eight hospitals, we will recruit and train Kidney Action Teams –
acting as a rapid response team for AKI – consisting of an advanced practitioner, a pharmacist and a
nephrologist. In a hub-and-spoke design, centralized Kidney Action Teams will make personalized
recommendations on AKI diagnosis and treatment based on electronic chart review. Kidney Action Team
recommendations will be created for all patients but delivered only in those randomized to the intervention.
This experimental design will determine: 1) whether real-time personalized recommendations for AKI diagnosis
and treatment improve improve patient outcomes; 2) which patients and providers are most likely to benefit
from e-consults of this type and 3) whether a fully automated rules engine can successfully mimic human-
derived recommendations. Such an automated system, if successful, would provide a highly generalizable
model for integration into other health systems.
