Precision-Medicine Diagnostic Support in Hospitalized Veterans With Acute Kidney Injury

Acute kidney injury (AKI), defined as a sudden loss of kidney function, affects up to 20% of hospitalized Veterans and is strongly associated with chronic kidney disease, poor quality of life, and death. Clinical practice guidelines recommend timely identification of the cause of AKI, but gaps remain in conducting the initial and subsequent diagnostic evaluation. Some causes of AKI also require specific treatments beyond supportive care, can be challenging to diagnose, and can require even more detailed evaluation including kidney biopsies. This clinical trial will evaluate the usability and feasibility of an Artificial Intelligence (AI)-assisted automated and comprehensive precision CDSS tool (PRECISE-AKI) to provide iterative cognitive support of general and nephrology-based providers in the diagnostic evaluation of hospitalized patients experiencing AKI within the Tennessee Valley Health Systems (TVHS). The investigators hypothesize that PRECISE-AKI will be acceptable, appropriate, and feasible to a variety of users and improve the diagnostic evaluation of hospitalized patients AKI.

• PRECISE-AKI Clinical Decision Support Tool (Other): The Intervention arm will consist of Clinical Decision Diagnostic Support (CDS) provided by the PRECISE-AKI tool

Primary outcomes

• Rates of Appropriate Diagnostic Testing [Up to 30 days]: Based on the presenting context, the investigators will compare rates of appropriate diagnostic testing between intervention and control patients among those meeting the AKI case definition

Other outcomes

• Exploratory Clinical Outcome: Peak Kidney Disease Improving Global Outcomes (KDIGO) AKI Stage during hospitalization. [During Index Hospitalization through 30 days]: For this exploratory clinical outcome, we will compare differences in the peak KDIGO AKI Stage (creatinine-based criteria) during hospitalization after meeting the case definition of AKI between intervention and control cases.
• Exploratory Clinical Outcome: Discharge serum creatinine [Last serum creatinine during index hospitalization through 30 days]: The investigators will compare differences in the hospital discharge serum creatinine after meeting the case definition of AKI between intervention and control cases.
• Exploratory Clinical Outcome: Major Adverse Kidney Events (MAKE) 90 [90 days]: For this exploratory clinical outcome, the investigators will compare the rates of the major adverse kidney events experienced by eligible AKI cases in the intervention compared with the control arm. Major Adverse Kidney Events will be defined as kidney replacement therapy, death, or an increase in baseline serum creatinine of 150% of baseline using the last serum creatinine available up to 90 days.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Eligible providers will be those that have at least 4 weeks of inpatient ward team or consultation team activity during a 12-month period.
* Case inclusion criteria will consist of hospitalizations that meet criteria for Kidney Disease Improving Global Outcomes Stage 2 injury or persistent Stage 1 injury seen by eligible providers.

Exclusion Criteria:

* Ineligible providers will be those that have < 4 weeks of inpatient ward team of consultative team activity during a 12 month period.
* Hospitalizations with non-persistent (<48 hours) stage 1 injury or less.

• Edward D Siew, MD MSc, Principal investigator, Tennessee Valley Healthcare System Nashville Campus, Nashville, TN
• Michael E Matheny, MD MS MPH, Principal investigator, Tennessee Valley Healthcare System Nashville Campus, Nashville, TN