Preventing Acute Kidney Injury
- Conditions
- Acute Kidney Injury
- Interventions
- Other: remote ischemic preconditioningOther: KDIGO guidelines
- Registration Number
- NCT04376619
- Lead Sponsor
- Atlantic Health System
- Brief Summary
Acute kidney injury increases the risk for chronic kidney disease, length of stay, readmissions and mortality. Currently the only way to diagnose acute kidney injury is with a serum creatinine or drop in urine output. Biomarkers for acute kidney injury are well elevated before rise in creatinine. Hypothesis is that by implementing an electronic alert system with an algorithm followed by remote ischemic preconditioning will prevent acute kidney injury.
- Detailed Description
The propose study is to incorporate an alert system in current medical health system and an algorithm will be used to activate clinicians and Nephrologist to confirm if patient is at high risk. Once identified as high risk the clinician and/or nephrologist will intervene and change current management if needed. First phase of study will look at an alert system and algorithm was enough to lower incidence of acute kidney injury. Phase 2 will also use alert system and algorithm that will be further randomized those that are identified as high risk for acute kidney injury to remote ischemic preconditioning.
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- any admitted patients that are not excluded by exclusion criteria
- Patients who's creatinine returns to baseline after admitted can be included in study if patient still remains admitted.
- End stage renal disease
- estimated glomerular filtration rate less then 20
- Left ventricular assist device patients
- observation status
- hospice patients
- pregnancy
- age less then 18
- acute kidney injury on admission defined as 1.5 times elevated creatinine prior to last admission's creatinine
- nephrology consult already placed
- renal transplant or nephrectomy within 1 year
- Patients unable to provide consent
exclusion for remote ischemic preconditioning in addition to above exclusion will be:
- symptoms or diagnosis of peripheral arterial disease
- Patients in shock defined by requiring inotropes or vasopressors
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description RIPC remote ischemic preconditioning part 2 of study, those identified as high risk of AKI will have Kidney Disease Improving Global Outcomes guidelines and RIPC implemented to see if this reduces incidence of AKI compared to part 2 of study KDIGO guidelines KDIGO guidelines Part 1 of study, those identified as high risk for AKI then will have Kidney Disease Global Improving outcomes guideline implemented to see if this reduces incidence of AKI
- Primary Outcome Measures
Name Time Method number of participants who required dialysis during hospitalization, up to three months need for initiation of dialysis after acute kidney injury develops during the admission
number of participants who developed acute kidney injury during hospitalization, up to three months development of acute kidney injury as measured by serum creatinine 1.5 times more then baseline
- Secondary Outcome Measures
Name Time Method number of participants who are placed on hospice or have expired at time of admission when enrolled in study to 1 year post discharge death or placed on hospice
number of participants who are readmitted discharged from when enrolled in study to 1 year post discharge readmissions to hospital within 1 year of first admission date
length of stay during hospitalization, up to three months starting from onset of acute kidney injury measured by elevated creatinine 1.5 times baseline creatinine to last day of discharged
progression to chronic kidney disease at time of admission when enrolled in study to 1 year post discharge measured by serum creatinine over 1 year on followup labs
number of participants who receive dialysis at time of admission when enrolled in study to 1 year post discharge initiation of dialysis starting from at time of admission to 1 year post discharge