{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:55:38Z","timestamp":1793310938139,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Objective<\/jats:title>\n To determine whether a structured early nephrology consultation triggered by a machine-learning acute kidney injury (AKI) risk score (electronic signal to prevent AKI [ESTOP-AKI]) in patients at high risk for stage 2 AKI improves patient outcomes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial was conducted at the University of Chicago, Illinois, from March 13, 2019, to August 21, 2024, in hospitalized patients with no serum creatinine (SCr)\u2013based AKI and an ESTOP-AKI score more than 0.01.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients were randomized to receive a structured early nephrology consultation (ENC) from an attending nephrologist or usual care (UC). The ENC included an in-person assessment and recommendations regarding volume status, kidney perfusion, medication dosing and selection, electrolytes, nutritional needs, and further testing. Patients in the UC arm only received a nephrology consultation when clinically requested by the primary team.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the peak change in SCr from enrollment (\u0394SCr) during the 7-day follow-up. Secondary outcomes included development of AKI, need for kidney replacement therapy, and inpatient and 90-day mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 180 patients randomized (median [IQR] age, 62.5 [50.0-71.0] years; 102 males [56.7%]), 89 (49.4%) received ENC, and 91 (50.6%) received UC. There was no significant adjusted mean (SE) difference in the 7-day \u0394SCr between the ENC and UC groups, adjusted for the ESTOP risk group (0.04 [0.07] mg\/dL vs \u22120.03 [0.07] mg\/dL;\n P<\/jats:italic>\n \u2009=\u2009.30), among the 70 patients (38.9%) in the development of stage 1 or higher AKI (37 [42%] vs 33 [36%];\n P<\/jats:italic>\n \u2009=\u2009.47) or among the 29 patients (16.1%) with stage 2 or higher AKI (17 [19%] vs 12 [13%];\n P<\/jats:italic>\n \u2009=\u2009.28). During the study period, there were 121 ENC consultations containing 270 recommendations compared with 19 UC consultations and 36 recommendations. Medication dosage and discontinuation, diuretics or fluids, and vasopressor recommendations were more likely to be completely followed in the UC arm (15 of 22 [68%]) compared with in the ENC arm (48 of 116 [41%]). Over the 90-day follow-up, there was no significant difference in readmission rates (ENC: 30 [34.1%] vs UC: 40 [44.4%];\n P<\/jats:italic>\n \u2009=\u2009.21) or 90-day mortality (ENC: 13 [14.8%] vs UC: 17 [18.7%];\n P<\/jats:italic>\n \u2009=\u2009.62) between the ENC and UC arms.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of structured ENC triggered by a machine-learning AKI risk score, there was no difference in \u0394SCr. AKI consultation recommendations were not followed the majority of time; whether increasing adherence to recommendations could improve outcomes deserves further study.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03590028<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.22554","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:30:21Z","timestamp":1783697421000},"page":"e2622554","source":"Crossref","is-referenced-by-count":1,"title":["Early Nephrology Consultation and Acute Kidney Injury in Hospitalized Patients"],"prefix":"10.1001","volume":"9","author":[{"given":"Matthew M.","family":"Churpek","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Wisconsin\u2013Madison"},{"name":"Department of Biostatistics and Medical Informatics, University of Wisconsin\u2013Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiman","family":"Fatima","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olasunkanmi","family":"Anjorin","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananya","family":"Saravanan","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin S.","family":"Ko","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Gunning","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan L.","family":"Prochaska","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tipu S.","family":"Puri","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L.","family":"Zisman","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana P.","family":"Edelson","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai C.","family":"Giurcanu","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay L.","family":"Koyner","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois"},{"name":"Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Chen","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melody","family":"Dias","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riley","family":"Hamilton","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa","family":"Kunczt","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Li","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Minna","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Trevino","sequence":"additional","affiliation":[{"name":"for the Electronic Signal to Prevent Acute Kidney Injury (ESTOP-AKI) Investigative Team"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"issue":"11","key":"zoi260627r1","doi-asserted-by":"publisher","first-page":"3365","DOI":"10.1681\/ASN.2004090740","article-title":"Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.","volume":"16","author":"Chertow","year":"2005","journal-title":"J Am Soc Nephrol"},{"issue":"6","key":"zoi260627r2","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1097\/SLA.0000000000000732","article-title":"Cost and mortality associated with postoperative acute kidney injury.","volume":"261","author":"Hobson","year":"2015","journal-title":"Ann Surg"},{"issue":"4","key":"zoi260627r3","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/S0002-9343(98)00058-8","article-title":"Independent association between acute renal failure and mortality following cardiac surgery.","volume":"104","author":"Chertow","year":"1998","journal-title":"Am J Med"},{"issue":"3","key":"zoi260627r4","doi-asserted-by":"publisher","first-page":"316","DOI":"10.34067\/KID.0005552022","article-title":"Health care resource utilization and costs of persistent severe acute kidney injury (PS-AKI) among hospitalized stage 2\/3 AKI patients.","volume":"4","author":"Koyner","year":"2023","journal-title":"Kidney360"},{"issue":"11","key":"zoi260627r6","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1007\/s00134-016-4670-3","article-title":"Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial.","volume":"43","author":"Meersch","year":"2017","journal-title":"Intensive Care Med"},{"issue":"3","key":"zoi260627r7","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1681\/ASN.2018090886","article-title":"An organizational-level program of intervention for AKI: a pragmatic stepped wedge cluster randomized trial.","volume":"30","author":"Selby","year":"2019","journal-title":"J Am Soc Nephrol"},{"issue":"8","key":"zoi260627r8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0200584","article-title":"The ICE-AKI study: impact analysis of a clinical prediction rule and electronic AKI alert in general medical patients.","volume":"13","author":"Hodgson","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"zoi260627r9","doi-asserted-by":"publisher","first-page":"2826","DOI":"10.1038\/s41467-023-38532-3","article-title":"A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes.","volume":"14","author":"Wilson","year":"2023","journal-title":"Nat Commun"},{"key":"zoi260627r10","doi-asserted-by":"publisher","first-page":"m4786","DOI":"10.1136\/bmj.m4786","article-title":"Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial.","volume":"372","author":"Wilson","year":"2021","journal-title":"BMJ"},{"issue":"24","key":"zoi260627r11","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1001\/jama.2024.22718","article-title":"Early, individualized recommendations for hospitalized patients with acute kidney injury: a randomized clinical trial.","volume":"332","author":"Aklilu","year":"2024","journal-title":"JAMA"},{"issue":"8","key":"zoi260627r12","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.12892","article-title":"Internal and external validation of a machine learning risk score for acute kidney injury.","volume":"3","author":"Churpek","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"7","key":"zoi260627r13","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1097\/CCM.0000000000003123","article-title":"The development of a machine learning inpatient acute kidney injury prediction model.","volume":"46","author":"Koyner","year":"2018","journal-title":"Crit Care Med"},{"issue":"10","key":"zoi260627r14","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1001\/jama.2022.1751","article-title":"Predictive accuracy of a perioperative laboratory test-based prediction model for moderate to severe acute kidney injury after cardiac surgery.","volume":"327","author":"Demirjian","year":"2022","journal-title":"JAMA"},{"issue":"1","key":"zoi260627r15","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1681\/ASN.2004040331","article-title":"A clinical score to predict acute renal failure after cardiac surgery.","volume":"16","author":"Thakar","year":"2005","journal-title":"J Am Soc Nephrol"},{"issue":"4","key":"zoi260627r16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0214904","article-title":"Improved predictive models for acute kidney injury with IDEA: Intraoperative Data Embedded Analytics.","volume":"14","author":"Adhikari","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"zoi260627r17","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1186\/s13054-019-2563-x","article-title":"Machine learning versus physicians\u2019 prediction of acute kidney injury in critically ill adults: a prospective evaluation of the AKIpredictor.","volume":"23","author":"Flechet","year":"2019","journal-title":"Crit Care"},{"issue":"6","key":"zoi260627r18","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1097\/SLA.0000000000002485","article-title":"Biomarker-Guided Intervention to Prevent Acute Kidney Injury after major surgery: the prospective randomized BigpAK study.","volume":"267","author":"G\u00f6cze","year":"2018","journal-title":"Ann Surg"},{"issue":"10521","key":"zoi260627r19","doi-asserted-by":"publisher","first-page":"2782","DOI":"10.1016\/S0140-6736(25)01717-9","article-title":"A preventive care strategy to reduce moderate or severe acute kidney injury after major surgery (BigpAK-2); a multinational, randomised clinical trial.","volume":"406","author":"Zarbock","year":"2025","journal-title":"Lancet"},{"issue":"2","key":"zoi260627r20","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1053\/j.ajkd.2010.08.026","article-title":"Early nephrologist involvement in hospital-acquired acute kidney injury: a pilot study.","volume":"57","author":"Balasubramanian","year":"2011","journal-title":"Am J Kidney Dis"},{"issue":"8","key":"zoi260627r21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070482","article-title":"Nephrology referral and outcomes in critically ill acute kidney injury patients.","volume":"8","author":"Costa e Silva","year":"2013","journal-title":"PLoS One"},{"issue":"4","key":"zoi260627r22","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1213\/ANE.0000000000004642","article-title":"A multinational observational study exploring adherence with the Kidney Disease: Improving Global Outcomes recommendations for prevention of acute kidney injury after cardiac surgery.","volume":"130","author":"K\u00fcllmar","year":"2020","journal-title":"Anesth Analg"},{"key":"zoi260627r23","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.08.013","article-title":"Variation in best practice measures in patients with severe hospital-acquired acute kidney injury: a multicenter study.","author":"Moledina","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"zoi260627r24","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020060897","article-title":"AKI treated with renal replacement therapy in critically ill patients with COVID-19.","author":"Gupta","year":"2021","journal-title":"J Am Soc Nephrol"},{"issue":"11","key":"zoi260627r25","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1001\/jamainternmed.2020.3596","article-title":"Factors associated with death in critically ill patients with coronavirus disease 2019 in the US.","volume":"180","author":"Gupta","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"20","key":"zoi260627r26","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.","volume":"310","author":"World Medical Association","year":"2013","journal-title":"JAMA"},{"key":"zoi260627r5","unstructured":"International Society of Nephrology. Kidney disease: improving global outcomes. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Supp. 2012. Accessed June 4, 2026. https:\/\/kdigo.org\/wp-content\/uploads\/2016\/10\/KDIGO-2012-AKI-Guideline-English.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2851536\/churpek_2026_oi_260627_1783018031.28601.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:30:24Z","timestamp":1783697424000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2851536"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.22554","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}