title: Acute kidney injury electronic alerts in primary care - findings from a large population cohort.
abstract: BACKGROUND
  Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.
  
  
  OBJECTIVE
  We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
  
  
  METHODS
  A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
  
  
  METHODS
  The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
  
  
  RESULTS
  28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
  
  
  CONCLUSIONS
  The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.
authors.affiliation: Welsh Renal Clinical Network, Cwm Taf University Health Board.
authors.forename: J
authors.initials: J
authors.lastname: Holmes
authors.affiliation: Redlands Surgery, Penarth, Cardiff and Vale University Health Board.
authors.forename: N
authors.initials: N
authors.lastname: Allen
authors.affiliation: Department of Clinical Biochemistry, Hywel Dda University Health Board.
authors.forename: G
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK.|Faculty of Life Sciences and Education, University of South Wales, UK.
authors.forename: J
authors.initials: J
authors.lastname: Geen
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Williams
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: A O
authors.initials: AO
authors.lastname: Phillips
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality; D000368:Aged; D002984:Clinical Laboratory Information Systems / Q000458:organization & administration*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology; D017216:Telemedicine / Q000379:methods*; D006113:United Kingdom