A recent study from Yale School of Medicine explored the impact of a "Kidney Action Team" on improving outcomes for hospitalized patients with acute kidney injury (AKI). The randomized clinical trial, published in JAMA, assessed whether personalized recommendations from a dedicated team could enhance patient care. While the intervention improved clinician adherence to recommended practices, it did not translate into better patient outcomes.
Study Design and Intervention
The study, conducted across Yale New Haven Health System and the Johns Hopkins Health System, involved 4,003 hospitalized patients. A kidney action team, comprising a clinician and pharmacist trained in AKI management, provided personalized diagnostic and therapeutic recommendations for patients in the intervention group. These recommendations were integrated into the patients' electronic health records. The control group received usual care without the team's input. Researchers monitored whether primary care providers implemented the recommendations within 24 hours and analyzed patient outcomes, including AKI worsening, dialysis initiation, and mortality, over a 14-day period.
Adherence Rates and Clinical Outcomes
The study revealed that clinicians followed approximately 34% of the kidney action team's recommendations, compared to 24% in the usual care group. According to Abinet Aklilu, MD, MPH, instructor of medicine (nephrology) and first author of the study, this improvement in adherence did not lead to tangible benefits for patients. "Despite improving provider adherence to these recommendations, the intervention did not improve patient outcomes," Aklilu stated.
Implications and Future Directions
The lack of improved patient outcomes despite increased adherence suggests that a more targeted approach may be necessary. Aklilu proposed focusing on specific subgroups of patients with AKI or those admitted to particular units. F. Perry Wilson, MD, MSCE, associate professor of medicine (nephrology) and public health (chronic disease epidemiology) and corresponding author of the study, highlighted the feasibility of implementing such interventions within hospital settings. "The kidney action team was remote; they weren’t running around to the bedside," Wilson said, emphasizing the efficiency of delivering recommendations through electronic health records.
Wilson also noted the need to advance clinical decision support interventions to demonstrate tangible improvements in patient outcomes. The study underscores the complexity of managing AKI in hospitalized patients and the importance of refining interventions to address specific clinical needs. Further research is needed to identify the optimal strategies for leveraging kidney action teams to improve outcomes for patients with AKI.
Acute Kidney Injury Context
Acute kidney injury is a common and serious complication in hospitalized patients, affecting up to 20% of this population, with even higher rates in intensive care units. AKI is associated with increased mortality, longer hospital stays, and significant healthcare costs. The condition can arise from various factors, including drug toxicity, urinary obstruction, dehydration, low blood pressure, and infection.
