James Matthew T, Dixon Elijah, Tan Zhi, Mathura Pamela, Datta Indraneel, Lall Rohan N, Landry Jennifer, Minty Evan P, Samis Gregory A, Winkelaar Gerald B, Pannu Neesh
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Kidney Int Rep. 2024 Jul 31;9(10):2996-3005. doi: 10.1016/j.ekir.2024.07.025. eCollection 2024 Oct.
Acute kidney injury (AKI) is common in the perioperative setting and associated with poor outcomes. Whether clinical decision support improves early management and outcomes of AKI on surgical units is uncertain.
In this cluster-randomized, stepped-wedge trial, 8 surgical units in Alberta, Canada were randomized to various start dates to receive an education and clinical decision support intervention for recognition and early management of AKI. Eligible patients were aged ≥18 years, receiving care on a surgical unit, not already receiving dialysis, and with AKI.
There were 2135 admissions of 2038 patients who met the inclusion criteria; mean (SD) age was 64.3 (16.2) years, and 885 (41.4%) were females. The proportion of patients who experienced the composite primary outcome of progression of AKI to a higher stage, receipt of dialysis, or death was 16.0% (178 events/1113 admissions) in the intervention group; and 17.5% (179 events/1022 admissions) in the control group (time-adjusted odds ratio, 0.76; 95% confidence interval [CI], 0.53-1.08; = 0.12). There were no significant differences between groups in process of care outcomes within 48 hours of AKI onset, including administration of i.v. fluids, or withdrawal of medications affecting kidney function. Both groups experienced similar lengths of stay in hospital after AKI and change in estimated glomerular filtration rate (eGFR) at 3 months.
An education and clinical decision support intervention did not significantly improve processes of care or reduce progression of AKI, length of hospital stays, or recovery of kidney function in patients with AKI on surgical units.
急性肾损伤（AKI）在围手术期很常见，且与不良预后相关。临床决策支持是否能改善外科病房AKI的早期管理及预后尚不确定。
在这项整群随机、阶梯式楔形试验中，加拿大艾伯塔省的8个外科病房被随机分配到不同的开始日期，以接受关于AKI识别和早期管理的教育及临床决策支持干预。符合条件的患者年龄≥18岁，在外科病房接受治疗，尚未接受透析，且患有AKI。
共有2038例符合纳入标准的患者入院2135次；平均（标准差）年龄为64.3（16.2）岁，女性885例（41.4%）。干预组中发生AKI进展至更高阶段、接受透析或死亡这一复合主要结局的患者比例为16.0%（178例事件/1113次入院）；对照组为17.5%（179例事件/1022次入院）（时间调整优势比，0.76；95%置信区间[CI]，0.53 - 1.08；P = 0.12）。在AKI发作后48小时内的护理过程结局方面，两组之间无显著差异，包括静脉输液的使用或停用影响肾功能的药物。两组在AKI后的住院时间以及3个月时估计肾小球滤过率（eGFR）的变化相似。
教育及临床决策支持干预并未显著改善外科病房AKI患者的护理过程，也未降低AKI的进展、住院时间或肾功能恢复情况。
