The influence of electronic acute kidney injury (AKI) alert on prognosis of adult hospitalized patients: a systematic review and meta-analysis
Authors' conclusion
The efficacy of AKI alerts remains inconclusive. Current evidence do not support or refute their effectiveness.
Study context
- Population
- Adult hospitalised patients
- Participants
- 170,696 participants · 22 studies
- Comparison
- Electronic AKI alert vs no alert
- Outcome
- Mortality and RRT rates
Methodological detailsRandomized controlled trials (RCTs), before-and-after and stepped-wedge studies, subgroup analysis
- RCTs, before-and-after and stepped-wedge studies
- Subgroup analysis
Pooled result
As reported in the abstract
AKI alert vs No alertRelative risk (95% CI)
Mortality, RCTs
1.02(0.97–1.07)
RRT use, RCTs
1.13(1.02–1.26)
- Mortality, non-RCTs: reduced
- 0.92 (RR; 95% CI 0.88-0.96)
- Renal replacement therapy (RRT) use, non-RCTs: no impact
- 1.08 (RR; 95% CI 0.87-1.36)
Further pooled results
| Outcome | Mean difference (95% CI) |
|---|---|
| Hospital LOS (RCTs)No effect | 0.04 (- 0.13 to 0.22) |
AKI progression (non-RCTs)
- Less AKI progression
- 0.85 (RR; 95% CI 0.77-0.94)
Kidney recovery (non-RCTs)
- Enhanced kidney recovery
- 1.65 (RR; 95% CI 1.56-1.75)
Nephrotoxic drug discontinuation (non-RCTs)
- Increased nephrotoxic drug discontinuation
- 1.20 (RR; 95% CI 1.13-1.28)
Drug review rates (non-RCTs)
- Higher drug review rates
- 1.19 (RR; 95% CI 1.17-1.21)
In-hospital mortality by response intensity (subgroup)
- Low response intensity: increased mortality
- 1.15 (RR; 95% CI 1.00-1.32)
- Moderate response intensity: reduced mortality
- 0.93 (RR; 95% CI 0.89-0.97)
- High response intensity: unclear effects
- 0.88 (RR; 95% CI 0.70-1.09)
Hospital type and region (subgroup)
- AKI alert favored in teaching hospitals and in several regions (Europe, North America and South America)
Original publication
The influence of electronic AKI alert on prognosis of adult hospitalized patients: a systematic review and meta-analysis. Crit Care. Published 12 May 2025. doi:10.
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