Early Nephrologist Involvement in Hospital-Acquired Acute Kidney Injury: A Pilot Study

Background: The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown. Study Design: Prospective controlled nonrandomized intervention study. Setting & Participants: We screened daily serum creatinine (SCr) levels of 4,296 patients admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 patients (8.2%) met the definition of in-hospital AKI (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 patients were enrolled in the control (standard care) and intervention groups, respectively. Intervention: Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of AKI. Outcome: Primary outcome defined as 2.5-fold increase in SCr level from admission. Measurement: Daily SCr until discharge. Results: The 2 groups had similar characteristics at baseline and at the time of AKI. The intervention was completed at a mean of 13.1 +/- 0.8 hours from the onset of AKI. Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9% of patients in the control group compared with 3.3% of patients in the EARLI group (P = 0.02). Patients in the EARLI group had a lower peak SCr level of 1.8 +/- 0.1 versus 2.1 +/- 0.2 mg/dL in controls (P = 0.01). Limitations: Single-center nonrandomized study of mostly US male veterans. Conclusions: Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings. Am J Kidney Dis. 57(2):228-234. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use.