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Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system
  1. Paloma Arias Pou1,
  2. Irene Aquerreta Gonzalez2,
  3. Antonio Idoate García2,
  4. Nuria Garcia-Fernandez2
  1. 1 Hospital Pharmacy, Clínica Universidad de Navarra, Madrid, Spain
  2. 2 Hospital Pharmacy, Clínica Universidad de Navarra, Pamplona, Spain
  1. Correspondence to Dr Paloma Arias Pou, Hospital Pharmacy, Clínica Universidad de Navarra, Madrid, 28036, Spain; parias{at}


Objective Electronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI.

Methods The study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians.

Results One-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01).

Conclusions A CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.

  • clinical decision support
  • alerting
  • acute kidney injury
  • drug prescription
  • nephrotoxic drugs

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