Preventing Acute Kidney Injury

Alert Kidney Intervention

Acute kidney injury increases the risk for chronic kidney disease, length of stay, readmissions and mortality. Currently the only way to diagnose acute kidney injury is with a serum creatinine or drop in urine output. Biomarkers for acute kidney injury are well elevated before rise in creatinine. Hypothesis is that by implementing an electronic alert system with an algorithm followed by remote ischemic preconditioning will prevent acute kidney injury.

The propose study is to incorporate an alert system in current medical health system and an algorithm will be used to activate clinicians and Nephrologist to confirm if patient is at high risk. Once identified as high risk the clinician and/or nephrologist will intervene and change current management if needed. First phase of study will look at an alert system and algorithm was enough to lower incidence of acute kidney injury. Phase 2 will also use alert system and algorithm that will be further randomized those that are identified as high risk for acute kidney injury to remote ischemic preconditioning.

Inclusion Criteria:

• any admitted patients that are not excluded by exclusion criteria
• Patients who's creatinine returns to baseline after admitted can be included in study if patient still remains admitted.

Exclusion Criteria:

• End stage renal disease
• estimated glomerular filtration rate less then 20
• Left ventricular assist device patients
• observation status
• hospice patients
• pregnancy
• age less then 18
• acute kidney injury on admission defined as 1.5 times elevated creatinine prior to last admission's creatinine
• nephrology consult already placed
• renal transplant or nephrectomy within 1 year
• Patients unable to provide consent

exclusion for remote ischemic preconditioning in addition to above exclusion will be:

• symptoms or diagnosis of peripheral arterial disease
• Patients in shock defined by requiring inotropes or vasopressors