• Vanessa Moll, Manxu Zhao, Steven Minear, Madhav Swaminathan, Andrea Kurz, Jiapeng Huang, K Gage Parr, Kelly Stanton, Ashish K Khanna, and PREDICT AKI Group.
• Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN; Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA. Electronic address: vmoll@umn.edu.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 1; 38 (10): 223822462238-2246.

Objective(S)Acute kidney injury (AKI) is defined and staged by reduced urine output (UO) and increased serum creatinine (SCr). UO is typically measured manually and documented in the electronic health record, making early and reliable detection of oliguria-based AKI and electronic data extraction challenging. The authors investigated the diagnostic performance of continuous UO, enabled by active drain line clearance-based alerts (Accuryn AKI Alert), compared with AKI stage 2 SCr criteria and their associations with length of stay, need for continuous renal replacement therapy, and 30-day mortality.DesignThis study was a prospective and retrospective observational study.SettingNine tertiary centers participated.ParticipantsCardiac surgery patients were enrolled.InterventionsNone.Measurements And Main ResultsA total of 522 patients were analyzed. AKI stages 1, 2, and 3 were diagnosed in 32.18%, 30.46%, and 3.64% of patients based on UO, compared with 33.72%, 4.60%, and 3.26% of patients using SCr, respectively. Continuous UO-based alerts diagnosed stage ≥1 AKI 33.6 (IQR =15.43, 95.68) hours before stage ≥2 identified by SCr criteria. A SCr-based diagnosis of AKI stage ≥2 has been designated a Hospital Harm by the Centers for Medicare & Medicaid Services. Using this criterion as a benchmark, AKI alerts had a discriminative power of 0.78. The AKI Alert for stage 1 was significantly associated with increased intensive care unit and hospital length of stay and continuous renal replacement therapy, and stage ≥2 alerts were associated with mortality.ConclusionsAKI Alert, based on continuous UO and enabled by active drain line clearance, detected AKI stages 1 and 2 before SCr criteria. Early AKI detection allows for early kidney optimization, potentially improving patient outcomes.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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