Shifts in Acute Kidney Injury Trends Post-Alert System Implementation: A Retrospective Observational Cohort Study

Rationale & Objective: Acute kidney injury (AKI), a complex syndrome involving multiple organ systems, requires timely intervention to prevent adverse outcomes.Despite the promise of AKI alert systems in improving early detection and management, their long-term effectiveness remains unevaluated.This study aimed to investigate the sustained impact of an AKI alert system over a decade of implementation.Study Design: Retrospective observational cohort study Setting & Participants: Conducted at a Korean tertiary hospital, analyzing 13,301 adult patients with AKI, from 246,650 admissions (2013-2023).Exposure: Introduction of an automated AKI alert system (implemented 2014.6)Outcomes: Primary outcomes included 14-day AKI recovery, stage progression, dialysis onset, and mortality.Process outcomes comprised early nephrology consultation, overlooked AKI cases, and discontinuation of nephrotoxic medications.Long-term outcome was assessed as 35% estimated glomerular filtration rate (eGFR) decline within 3 years.Analytical Approach: Outcomes were compared across pre-alert (2013.1-2014.5),alert implementation (2014.6-2019.12),and pandemic (2020.1-2023.12)phases, using adjusted multivariable logistic analyses calculating unadjusted and covariate-adjusted odds ratios (ORs).Interrupted time series analysis evaluated temporal trends.Results: AKI recovery rates increased substantially in both alert implementation and pandemic phases (adjusted OR 2.40 [95% confidence interval (CI) 2.16-2.66]and 2.19 [1.94-2.47],respectively).Early nephrology consultation improved significantly (adjusted OR 3.33 [2.81-3.95]and 2.65 [2.20-3.19]),and overlooked AKI cases decreased (adjusted OR 0.49 [0.43-0.55]and 0.43 [0.36-0.51]).Long-term renal outcomes showed lower risk of significant