Division of Nephrology and Hypertension.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Curr Opin Crit Care. 2023 Dec 1;29(6):542-550. doi: 10.1097/MCC.0000000000001105. Epub 2023 Oct 3.
Acute kidney injury (AKI) is a highly prevalent clinical syndrome that substantially impacts patient outcomes. It is accepted by the clinical communities that the management of AKI is time-sensitive. Unfortunately, despite growing proof of its preventability, AKI management remains suboptimal in community, acute care, and postacute care settings. Digital health solutions comprise various tools and models to improve care processes and patient outcomes in multiple medical fields. AKI development, progression, recovery, or lack thereof, offers tremendous opportunities for developing, validating, and implementing digital health solutions in multiple settings. This article will review the definitions and components of digital health, the characteristics of AKI that allow digital health solutions to be considered, and the opportunities and threats in implementing these solutions.
Over the past two decades, the academic output related to the use of digital health solutions in AKI has exponentially grown. While this indicates the growing interest in the topic, most topics are primarily related to clinical decision support by detecting AKI within hospitals or using artificial intelligence or machine learning technologies to predict AKI within acute care settings. However, recently, projects to assess the impact of digital health solutions in more complex scenarios, for example, managing nephrotoxins among adults of pediatric patients who already have AKI, is increasing. Depending on the type of patients, chosen digital health solution intervention, comparator groups, and selected outcomes, some of these studies showed benefits, while some did not indicate additional gain in care processes or clinical outcomes.
Careful needs assessment, selection of the correct digital health solution, and appropriate clinical validation of the benefits while avoiding additional health disparities are moral, professional, and ethical obligations for all individuals using these healthcare tools, including clinicians, data scientists, and administrators.
急性肾损伤（AKI）是一种高发的临床综合征，对患者预后有重大影响。临床界普遍认为 AKI 的管理是有时效性的。不幸的是，尽管已经有越来越多的证据表明 AKI 可以预防，但在社区、急性护理和康复护理环境中，AKI 的管理仍然不尽人意。数字健康解决方案包括各种工具和模型，可改善多个医疗领域的护理流程和患者预后。AKI 的发生、进展、恢复或缺乏恢复，为在多个环境中开发、验证和实施数字健康解决方案提供了巨大的机会。本文将回顾数字健康的定义和组成部分、AKI 的特征，这些特征使数字健康解决方案得以考虑，以及实施这些解决方案的机会和威胁。
在过去的二十年中，与 AKI 中使用数字健康解决方案相关的学术产出呈指数级增长。虽然这表明人们对该主题的兴趣日益浓厚，但大多数主题主要与在医院内检测 AKI 的临床决策支持相关，或使用人工智能或机器学习技术预测急性护理环境中的 AKI。然而，最近，评估数字健康解决方案在更复杂场景中的影响的项目正在增加，例如，管理儿科患者中已经患有 AKI 的成人的肾毒性药物。取决于患者类型、选择的数字健康解决方案干预、对照群体和选定的结果，这些研究中的一些表明有获益，而一些则没有表明在护理流程或临床结果方面有额外的获益。
临床医生、数据科学家和管理人员等所有使用这些医疗保健工具的人都有道德、专业和伦理义务，需要仔细进行需求评估、选择正确的数字健康解决方案，并在避免额外健康差异的同时，对效益进行适当的临床验证。
