Introduction:
Acute kidney injury (AKI) is increasingly recognized as a major global health concern, affecting over 133 million people annually, with a particularly significant burden in developing countries. Electronic alerts (e-alerts) have been implemented in various healthcare settings to improve AKI detection and management. However, their effectiveness in improving clinical outcomes, such as mortality, dialysis requirements, and healthcare resource utilization, remains uncertain. The purpose of this study is to systematically review and analyze the impact of e-alerts on AKI management outcomes in hospitalized patients.
Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2000 and December 2023. The studies included hospitalized patients who received e-alerts for AKI. The primary outcomes evaluated were kidney injury progression, dialysis during hospitalization, and mortality. Secondary outcomes included healthcare resource utilization, such as nephrology consultations. Data were pooled, and meta-analyses were performed for relevant outcomes, expressed as risk ratios (RR) with 95% confidence intervals (CI), with heterogeneity assessed using I² statistics.
Results:
The search identified 4 eligible studies, all of which utilized automated e-alert systems integrated into electronic health records. A meta-analysis of mortality outcomes revealed no significant difference between the e-alert group and the usual care group, with a pooled risk ratio of 1.06 (95% CI 0.86 to 1.31; I² = 0%). Similarly, the analysis for dialysis during hospitalization showed no significant difference, with a pooled risk ratio of 0.96 (95% CI 0.78 to 1.20; I² = 0%). However, the outcomes related to nephrology consultations displayed significant heterogeneity, with a pooled odds ratio of 1.62 (95% CI 0.72 to 3.68; I² = 84%). A new study focusing on medication-targeted e-alerts demonstrated a modest, non-significant reduction in the composite outcome of AKI progression, dialysis, or death in the e-alert group (23.1%) compared to the usual care group (25.3%) (RR 0.92, 95% CI 0.83 to 1.01, p-value = 0.09). Subgroup analysis from this study showed a significant benefit in patients receiving proton pump inhibitors (PPIs) (RR 0.88, 95% CI 0.79 to 0.98, p-value = 0.02).
Conclusions:
The current evidence indicates that e-alerts for AKI do not significantly improve survival or reduce the need for renal replacement therapy. However, e-alerts may increase nephrology consultations, and medication-targeted alerts could provide benefits in specific subgroups, such as patients on proton pump inhibitors. Further research, particularly employing mixed methods, is necessary to better understand the impact of e-alerts and enhance their effectiveness in clinical practice.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.