Medication-targeted AKI alerts may benefit patients on proton pump inhibitors
Click Here to Manage Email Alerts
ORLANDO — An increase in discontinuation of medications that could have a positive impact on kidney outcomes resulted from a medication-targeted AKI alert, according to a presenter at ASN Kidney Week.
In a pragmatic, open-label, parallel group, randomized controlled trial, researchers examined 5,060 patients hospitalized with AKI and an active order for any of the following three classes of medications of interest (MOI):NSAIDs, renin angiotensin-aldosterone system inhibitors or proton pump inhibitors (PPIs).
“Now, these were chosen because the empirical evidence for how physicians behave around these drugs in the setting of AKI differ,” Francis P. Wilson, MD, MS, from Yale School of Medicine, said in a late-breaking presentation.
Researchers sought to determine if an electronic “pop-up” message, flagging the MOIs for potential discontinuation would improve clinical outcomes of AKI progression, dialysis or death rates within 14 days or hospital discharge.
Researchers identified an MOI discontinuation in 61.1% of the alert group and 55.9% in the usual care group. Further, clinical outcomes were improved in 23.1% of the alert group and 25.3% of those in the usual care group.
“There was a significant improvement in the composite clinical outcome favoring the alert among the population, who receiving PPI at the time, were randomized,” Wilson said.
As for why this benefit occurred, Wilson suggested PPIs are an underrecognized contributor to AKI in hospitalized patients, patients receiving PPI have unique characteristics and phenotypes, and the possibility of an alpha error.
He added, “Automated alerts for PPI can increase the rate of cessation of potential for toxic medications without endangering patients. There's limited evidence that these alerts change clinical outcomes thus far, but the main clinical benefit of alerts among patients who are receiving PPIs that clearly warrants further research.”
Collapse
Wilson FP, et al. FR-OR63. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
Read more about
Click Here to Manage Email Alerts