A randomized clinical trial conducted by Yale University School of Medicine researchers revealed that tailored electronic health record (EHR) alerts, designed to improve the management of acute kidney injury (AKI) in hospitalized patients, did not significantly improve kidney outcomes. The study, known as the KAT-AKI trial, was presented at the American Society of Nephrology’s Kidney Week 2024.
The trial assessed whether a tailored support tool could improve interventions and outcomes for hospitalized patients with AKI. The tool sent alerts to a kidney action team, comprising a study physician and pharmacist, providing personalized recommendations within one hour of AKI detection. These recommendations covered diagnostic testing, volume management, potassium levels, acid-base balance, and medication adjustments.
The primary outcome was a composite of AKI progression to a higher stage, dialysis initiation, or mortality during hospitalization, within 14 days of randomization. A key secondary outcome was the proportion of recommendations completed within 24 hours of randomization.
Study Details and Results
The study involved 4003 patients with a median age of 72 years; 47% were female, and 23% were Black. Participants were randomized to either the intervention arm (n=1999) or the usual care group (n=2004). A total of 14,539 recommendations were made, with a median of 3 per patient. The most frequent recommendations were in the categories of general diagnostics and monitoring (96.2%) and volume management (79.8%).
The primary outcome analysis showed no significant difference between the intervention group (19.8%) and the usual care group (18.4%) (Relative Risk [RR], 1.07; 95% CI, 0.94 to 1.22; P = .28). Similarly, no significant differences were observed in AKI progression (13.5% vs 13.0%), dialysis receipt (1.6% vs 1.5%), or mortality incidence (9.6% vs 9.2%).
Further analysis indicated that 33.8% of recommendations were implemented in the intervention group, compared to 24.3% in the usual care group (mean difference, 9.5%; 95% CI, 8.1% to 11.0%).
Expert Commentary
Lead investigator Abinet M. Aklilu, MD, MPH, of Yale University School of Medicine, stated, “We found that the intervention significantly improved several clinician behaviors regarding the management of AKI but did not reduce the primary outcome of developing worsening kidney injury, needing dialysis, or death.”
Future Directions
Aklilu added, “In future studies, we plan to assess if recommendations targeting individuals at high risk for severe kidney injury and specific phenotypes of kidney injury lead to improved outcomes.”
