{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:46:12Z","timestamp":1792788372942,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/f1000research.178438.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000}}],"reference-count":48,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This review was supported by The Indonesia Endowment Fund for Education","award":["LOG-6839\/LPDP.3\/2025."],"award-info":[{"award-number":["LOG-6839\/LPDP.3\/2025."]}],"id":[{"id":"https:\/\/ror.org\/05p2xef58","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    Background Optimization of renal drug dosing to avoid drug toxicity is essential in Chronic Kidney Disease (CKD), yet prescribing errors are common. CDSS with rule-based and AI\/ML based tools are used to address this safety gap; however, their impact remains uncertain. Methods We performed a PRISMA-guided systematic review and meta-analysis of RCTs comparing rule-based or AI\/ML CDSS with usual care comparators among adults with CKD or at risk of CKD-related prescribing errors. The primary outcome was a medication safety endpoint aligned with the CDSS logic (appropriate renal dosing, potentially inappropriate prescribing, and medication errors). To address heterogeneity, we supplemented meta-analysis with a structured Best Evidence Synthesis and trial-level mapping by delivery mode and workflow stage. Results Among 20 RCTs meeting inclusion criteria, 6 provided meta-analytic data. Pooled across four trials, CDSS improved appropriate renal dosing (RR 1.76; 95% CI 1.13\u20132.74), but heterogeneity was extreme (I\n                    <ns4:sup>2<\/ns4:sup>\n                    = 97%) and the 95% prediction interval (0.75\u20134.14) crossed the null; the pooled estimate is therefore a context-dependent average rather than a transportable effect, and benefit cannot be assured in a new setting. A consistent direction of effect favoring CDSS came instead from the Best Evidence Synthesis. Documentation of CKD in electronic health records improved consistently (RR 1.19; 95% CI 1.07\u20131.32; I\n                    <ns4:sup>2<\/ns4:sup>\n                    = 0%). Current evidence was predominantly interruptive order-entry interventions; clinician compliance ranged 17\u201374% owing to alert fatigue, time constraints, and unclear system function and override processes.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.178438.2","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:59:06Z","timestamp":1787896746000},"page":"532","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Medication Safety in Chronic Kidney Disease Using Rule-Based and Artificial Intelligence\u2013Based Clinical Decision Support Systems: A Systematic Review of Randomized Controlled Trials"],"prefix":"10.12688","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5959-469X","authenticated-orcid":false,"given":"Asrul","family":"Ismail","sequence":"first","affiliation":[{"name":"Depok West Java 16424 Clinical and Social Pharmacy Laboratory, Faculty of Pharmacy, Universitas Indonesia"},{"name":"Depok West Java 16424 Health Innovation Study and Policy Research Group, Faculty of Pharmacy, Universitas Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7861-4369","authenticated-orcid":false,"given":"Rani","family":"Sauriasari","sequence":"additional","affiliation":[{"name":"Depok West Java 16424 Clinical and Social Pharmacy Laboratory, Faculty of Pharmacy, Universitas Indonesia"},{"name":"Depok West Java 16424 Health Innovation Study and Policy Research Group, Faculty of Pharmacy, Universitas Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arry","family":"Yanuar","sequence":"additional","affiliation":[{"name":"Biomedical Computation and Drug Design Research Group Depok West Java 16424 Faculty of Pharmacy, Universitas Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dodi","family":"Sudiana","sequence":"additional","affiliation":[{"name":"Depok West Java 16424 Department of Electrical Engineering, Faculty of Engineering, Universitas Indonesia, Kampus UI"},{"name":"Depok West Java 16424 Artificial Intelligence and Data Engineering Research Center (AIDE-RC), Faculty of Engineering, Universitas Indonesia, Kampus UI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fonny","family":"Cokro","sequence":"additional","affiliation":[{"name":"South Jakarta DKI Jakarta 12930 Department of Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University"},{"name":"Depok West Java 16424 Health Innovation Study and Policy Research Group, Faculty of Pharmacy, Universitas Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"473-485","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: an international consensus.","volume":"20","author":"A Francis","year":"2024","journal-title":"Nat. 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The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}