The initial development and assessment of an automatic alert warning of acute kidney injury

Nephrol Dial Transplant. 2011 Jul;26(7):2161-8. doi: 10.1093/ndt/gfq710. Epub 2010 Dec 8.


Background: Acute kidney injury (AKI) recognition by clinicians has been shown to be suboptimal. Little work has focused on the use of an automated warning of a rise in a patient's creatinine, indicating AKI.

Methods: Over 3 months in 2008 we ran a prospective observational study of 'alerts' sent by our Integrated Clinical Environment pathology system, identifying all patients with a ≥ 75% rise in their creatinine from its previous value. Information was collected on subsequent renal function, comorbidities and other potential predictors of survival.

Results: In the 3-month period 463 adults with a first episode of AKI were identified by an alert; 87% were hospital inpatients. Median follow-up was 404 days. In-hospital mortality was 36% for those who were admitted. After performing Weibull survival analysis, significant predictors of poorer survival were the presence of metastatic, haematological or lower risk malignancy, a residential or nursing home address and higher age, number of non-malignant comorbidities or C-reactive protein level. Predictors of better survival were higher serum albumin level or nadir GFR during the episode and Indian subcontinent ethnicity. A receiver-operator curve for a prognostic score developed from the analysis showed an area under the curve of 0.84.

Conclusions: The alerts identified a group of AKI patients who are at moderately high risk of death. The prognostic score using a combination of covariates shows early promise. Both the alerts and the score warrant further development as tools for earlier intervention in AKI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / prevention & control*
  • Adolescent
  • Adult
  • Aged
  • Automation
  • C-Reactive Protein / metabolism
  • Creatinine / blood*
  • Female
  • Glomerular Filtration Rate
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Time Factors
  • Young Adult


  • C-Reactive Protein
  • Creatinine