title: Early nephrologist involvement in hospital-acquired acute kidney injury: a pilot study.
abstract: BACKGROUND
  The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown.
  
  
  METHODS
  Prospective controlled nonrandomized intervention study.
  
  
  METHODS
  We screened daily serum creatinine (SCr) levels of 4,296 patients admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 patients (8.2%) met the definition of in-hospital AKI (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 patients were enrolled in the control (standard care) and intervention groups, respectively.
  
  
  METHODS
  Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of AKI.
  
  
  RESULTS
  Primary outcome defined as 2.5-fold increase in SCr level from admission.
  
  
  METHODS
  Daily SCr until discharge.
  
  
  RESULTS
  The 2 groups had similar characteristics at baseline and at the time of AKI. The intervention was completed at a mean of 13.1 ± 0.8 hours from the onset of AKI. Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9% of patients in the control group compared with 3.3% of patients in the EARLI group (P = 0.02). Patients in the EARLI group had a lower peak SCr level of 1.8 ± 0.1 versus 2.1 ± 0.2 mg/dL in controls (P = 0.01).
  
  
  CONCLUSIONS
  Single-center nonrandomized study of mostly US male veterans.
  
  
  CONCLUSIONS
  Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings.
authors.affiliation: Saint Louis Veterans Affairs Medical Center, MO, USA.
authors.forename: Geetha
authors.initials: G
authors.lastname: Balasubramanian
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Al-Aly
authors.forename: Abdul
authors.initials: A
authors.lastname: Moiz
authors.forename: Michael
authors.initials: M
authors.lastname: Rauchman
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Zhang
authors.forename: Rajalakshmi
authors.initials: R
authors.lastname: Gopalakrishnan
authors.forename: Sumitra
authors.initials: S
authors.lastname: Balasubramanian
authors.forename: Tarek M
authors.initials: TM
authors.lastname: El-Achkar
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D000368:Aged; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D006787:Hospitals, Veterans; D006801:Humans; D007297:Inpatients; D008297:Male; D008923:Missouri; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation; D051437:Renal Insufficiency / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D003404:Creatinine