Multi-hospital electronic decision support for drug-associated acute kidney injury (MEnD-AKI): Study protocol for a randomized clinical trial.

Background And Objectives: Tools to assist with drug management for both nephrotoxic medications and renally eliminated drugs are urgently needed. "Multi-hospital Electronic Decision Support for Drug-associated Acute Kidney Injury" (MEnD-AKI) aims to examine the effect of a pharmacist-led intervention augmented with predictive analytics in the form of electronic alerts delivered to pharmacists followed by drug management recommendations provided to physicians via telemedicine for the early management of patients at risk of developing AKI or progressing to higher AKI stages.

Design: Prospective, multi-site, cluster-randomized clinical trial.

Pregnancy-associated acute kidney injury - consensus report of the 32nd Acute Disease Quality Initiative workgroup.

Acute kidney injury (AKI) during pregnancy and the postpartum period, known as pregnancy-associated AKI (PrAKI), is an important health concern and driver of health inequity worldwide. Causes of PrAKI include sepsis, autoimmune disorders and pregnancy-specific pathologies such as hypertensive disorders. Common risk factors include maternal comorbidities and use of nephrotoxic medications.

Association of hospital-level continuous kidney replacement therapy use and mortality in critically ill patients with acute kidney injury.

Purpose: In numerous high-risk medical and surgical conditions, an increased volume of patients and procedures is associated with improved processes and survival. This study examined the association of hospital-level continuous kidney replacement therapy (CKRT) utilization rates with all-cause hospital mortality in critically ill patients with acute kidney injury (AKI).

Methods: This multicenter cohort study used data from patients admitted to the intensive care unit (ICU) within the Premier Incorporated AI (PINC-AI) database.

Association of vasopressor use during renal replacement therapy and mortality.

Among critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) whether vasopressor use is associated with outcomes is unclear. We examined the association of vasopressor use following RRT initiation with in-hospital mortality in critically ill adults with AKI requiring different modalities of RRT. This observational study was conducted using the Premier Inc.

Prediction of intradialytic hypotension by machine learning: A systematic review.

Background: Intradialytic hypotension is associated with increased morbidity, and mortality. Several machine learning (ML) algorithms have been recently developed to predict intradialytic hypotension. We systematically reviewed ML models employed to predict intradialytic hypotension, their performance, methodological integrity, and clinical applicability.

Behind the scenes: Key lessons learned from the RELIEVE-AKI clinical trial.

Continuous kidney replacement therapy (CKRT) is commonly used to manage critically ill patients with severe acute kidney injury. While recent trials focused on the correct dosing and timing of CKRT, our understanding regarding the optimum dose of net ultrafiltration is limited to retrospective data. The Restrictive versus Liberal Rate of Extracorporeal Volume Removal Evaluation in Acute Kidney Injury (RELIEVE-AKI) trial has been conducted to assess the feasibility of a prospective randomized trial in determining the optimum net ultrafiltration rate.

Lung Protective Ventilation during Pregnancy: An Observational Cohort Study.

 We sought to describe characteristics of mechanically ventilated pregnant patients, evaluate utilization of low-tidal-volume ventilation (LTVV) and high-tidal-volume ventilation (HTVV) by trimester, and describe maternal and fetal outcomes by ventilation strategy.  This is a retrospective cohort study of pregnant women with mechanical ventilation for greater than 24 hours between July 2012 and August 2020 at a tertiary care academic medical center. We defined LTVV as average daily tidal volume 8 mL/kg of less of predicted body weight, and HTVV as greater than 8 mL/kg.

Contrast-associated acute kidney injury and cardiovascular events: a secondary analysis of the PRESERVE cohort.

Background: Contrast-associated acute kidney injury (CA-AKI) has been associated with a higher risk of cardiovascular (CV) events. We studied the risk of CV events in chronic kidney disease (CKD) patients undergoing angiography and whether biomarkers can predict such events. We also explored whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate (eGFR) on CV events.

Fluid Management during Continuous Renal Replacement Therapy: A Case-Based Approach.

Continuous renal replacement therapy (CRRT) is frequently used for fluid management of critically ill patients with acute or chronic kidney failure. There is significant practice variation worldwide in fluid management during CRRT. Multiple clinical studies have suggested that both the magnitude and duration of fluid overload are associated with morbidity and mortality in critically ill patients.

Forecasting imminent atrial fibrillation in long-term electrocardiogram recordings.

Background: Despite the morbidity associated with acute atrial fibrillation (AF), no models currently exist to forecast its imminent onset. We sought to evaluate the ability of deep learning to forecast the imminent onset of AF with sufficient lead time, which has important implications for inpatient care.

Methods: We utilized the Physiobank Long-Term AF Database, which contains 24-h, labeled ECG recordings from patients with a history of AF.

Economic Analysis of Renal Replacement Therapy Modality in Acute Kidney Injury Patients With Fluid Overload.

Unlabelled: Acute kidney injury (AKI) and fluid overload (FO) are among the top reasons to initiate intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). Prior research suggests CRRT provides more precise volume control, but whether CRRT is cost-effective remains unclear. We assessed the cost-effectiveness of CRRT for volume control compared with IHD from a U.

Digital health and acute kidney injury: consensus report of the 27th Acute Disease Quality Initiative workgroup.

Acute kidney injury (AKI), which is a common complication of acute illnesses, affects the health of individuals in community, acute care and post-acute care settings. Although the recognition, prevention and management of AKI has advanced over the past decades, its incidence and related morbidity, mortality and health care burden remain overwhelming. The rapid growth of digital technologies has provided a new platform to improve patient care, and reports show demonstrable benefits in care processes and, in some instances, in patient outcomes.

Restrictive versus Liberal Rate of Extracorporeal Volume Removal Evaluation in Acute Kidney Injury (RELIEVE-AKI): a pilot clinical trial protocol.

Introduction: Observational studies have linked slower and faster net ultrafiltration (UF) rates during kidney replacement therapy (KRT) with mortality in critically ill patients with acute kidney injury (AKI) and fluid overload. To inform the design of a larger randomised trial of patient-centered outcomes, we conduct a feasibility study to examine restrictive and liberal approaches to UF during continuous KRT (CKRT).

Methods And Analysis: This study is an investigator-initiated, unblinded, 2-arm, comparative-effectiveness, stepped-wedged, cluster randomised trial among 112 critically ill patients with AKI treated with CKRT in 10 intensive care units (ICUs) across 2 hospital systems.

A deep learning-based dynamic model for predicting acute kidney injury risk severity in postoperative patients.

Background: Acute kidney injury is a common postoperative complication affecting between 10% and 30% of surgical patients. Acute kidney injury is associated with increased resource usage and chronic kidney disease development, with more severe acute kidney injury suggesting more aggressive deterioration in clinical outcomes and mortality.

Methods: We considered 42,906 surgical patients admitted to University of Florida Health (n = 51,806) between 2014 and 2021.

Kidney Cell Cycle Arrest and Cardiac Biomarkers and Acute Kidney Injury Following Angiography: The Prevention of Serious Adverse Events Following Angiography (PRESERVE) Study.

Rationale & Objective: Recent studies in patients with chronic kidney disease (CKD) indicate that most cases of contrast-associated acute kidney injury (CA-AKI) are mild and are not associated with elevation in kidney injury biomarkers. We used highly sensitive kidney cell cycle arrest and cardiac biomarkers to assess the risk of CA-AKI and major adverse kidney events in patients with CKD undergoing angiography.

Study Design: A retrospective study.

Recovery after AKI: Effects on outcomes over 15 years.

Purpose: To examine the effect of kidney recovery on mortality, dialysis and kidney transplantation up to 15 years after AKI.

Materials And Methods: We studied 29,726 survivors of critical illness and compared these outcomes stratified by AKI and recovery status at hospital discharge. Kidney recovery was defined as a return of serum creatinine to ≤150% of baseline without dialysis prior to hospital discharge.

Case presentations of medication management for patients at risk for drug-associated acute kidney injury identified with a CDS system and a novel biomarker.

Purpose: Traditional methods used to evaluate changes in kidney function to identify acute kidney injury (AKI) have significant limitations. Damage biomarkers can identify patients at risk for AKI prior to changes in kidney function. While clinical trials have shown that biomarker-guided treatment can improve outcomes, whether these biomarkers can influence providers' choice of treatment strategy for risk prediction, surveillance, or diagnostic evaluation in clinical practice is uncertain.

Fluid Overload and Precision Net Ultrafiltration in Critically Ill Patients.

Background: Fluid overload is present in two-thirds of critically ill patients with acute kidney injury and is associated with morbidity, mortality, and increased healthcare resource utilization. Kidney replacement therapy (KRT) is frequently used for net fluid removal (i.e.