Implementation of Alert System for Early Diagnosis of Acute Kidney Injury: Paving the Way for National Public Health Advisory in India

This study is the first attempt to create and implement an alert system to facilitate early diagnosis and timely intervention for management of Acute Kidney Injury in India. An algorithm was created to retrospectively track rise in serum creatinine (SCr) as per the KDIGO guidelines. Participants > 18 years of age with a baseline SCr < 4 mg/dl were included. Clinical history, including 53 features associated with AKI, were recorded and statistical analyses were performed. With excellent sensitivity (99.53%), specificity (98.60%), and diagnostic accuracy (Youden's index 0.98), true positive alerts were generated for 214 of 4439 patients. 75.2% patients were critically-ill, with primary diagnosis of cardiac, pulmonary and nephrological events and co-morbidities such as hypertension, diabetes mellitus and CKD. Only 40.2% patients had a documented clinical diagnosis of AKI. The overall in-hospital mortality rate was 21%. Sub-group analysis revealed worse outcomes in stage 3 AKI patients. De-novo AKI patients had a higher risk of death compared to AKI on CKD patients. In this pre-implementation phase of our study, we saw an increased burden in patient outcomes owing to low diagnosis rate of AKI. It is imperative that we implement the alert system in real-time to assist physicians in early diagnosis of AKI.