• Nicholas M Selby, Lisa Crowley, Richard J Fluck, Christopher W McIntyre, John Monaghan, Nigel Lawson, and Nitin V Kolhe.
• Department of Renal Medicine, Royal Derby Hospital, Derby, UK. nick.selby@nhs.net
• Clin J Am Soc Nephrol. 2012 Apr 1;7(4):533-40.

Background And ObjectivesMany patients with AKI are cared for by non-nephrologists. This can result in variable standards of care that contribute to poor outcomes.Design, Setting, Participants, & MeasurementsTo improve AKI recognition, a real-time, hospital-wide, electronic reporting system was designed based on current Acute Kidney Injury Network criteria. This system allowed prospective data collection on AKI incidence and outcomes such as mortality rate, length of hospital stay, and renal recovery. The setting was a 1139-bed teaching hospital with a tertiary referral nephrology unit.ResultsAn electronic reporting system was successfully introduced into clinical practice (false positive rate, 1.7%; false negative rate, 0.2%). The results showed that there were 3202 AKI episodes in 2619 patients during the 9-month study period (5.4% of hospital admissions). The in-hospital mortality rate was 23.8% and increased with more severe AKI (16.1% for stage 1 AKI versus 36.1% for stage 3) (P<0.001). More severe AKI was associated with longer length of hospital stay for stage 1 (8 days; interquartile range, 13) versus 11 days for stage 3 (interquartile range, 16) (P<0.001) and reduced chance of renal recovery (80.0% in stage 1 AKI versus 58.8% in stage 3) (P<0.001). Utility of the Acute Kidney Injury Network criteria was reduced in those with pre-existing CKD.ConclusionsAKI is common in hospitalized patients and is associated with very poor outcomes. The successful implementation of electronic alert systems to aid early recognition of AKI across all acute specialties is one strategy that may help raise standards of care.

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