Acute kidney injury is common among hospitalized individuals, particularly those exposed to certain medications, and is associated with substantial morbidity and mortality. In a pragmatic, open-label, parallel group randomized controlled trial (clinicaltrials.gov NCT02771977), we investigate whether an automated clinical decision support system affects discontinuation rates of potentially nephrotoxic medications and improves outcomes in patients with AKI. Participants included 5,060 hospitalized adults with AKI and an active order for any of three classes of medications of interest: non-steroidal anti-inflammatory drugs, renin-angiotensin-aldosterone system inhibitors, or proton pump inhibitors. Within 24 hours of randomization, a medication of interest was discontinued in 61.1% of the alert group versus 55.9% of the usual care group (relative risk 1.08, 1.04–1.14, p=0.0003). The primary outcome – a composite of progression of acute kidney injury, dialysis, or death – occurred in 585 (23.1%) individuals in the alert group and 639 (25.3%) patients in the usual care group (RR 0.92, 0.83–1.01, p=0.09). The pre-specified subgroup analysis found a significant benefit of alerting among those exposed to proton pump inhibitors but not non-steroidal anti-inflammatory drug or renin-angiotensin system inhibitor.

Data was collected through electronic medical record abstraction in the context of a prospective, randomized clinical trial.