Real-Time Acute Kidney Injury Perioperative Prediction Clinical Trial (ML-AKI)
19 mai 2026 mis à jour par: University of California, San Francisco
Prediction of Acute Kidney Injury (AKI) After Surgery: A Pragmatic Three-Arm Cluster-Randomized Trial
This investigator-initiated, pragmatic trial evaluates whether displaying a machine learning (ML)- derived perioperative AKI risk score-alone or paired with an interruptive Best/Our Practice Advisory (BPA/OPA)-improves kidney-protective care and reduces kidney injury after non-obstetric surgery at UCSF.
Approximately 75-100 attending anesthesiologists (clusters) are randomized 1:1:1 to: (a) Control (risk score hidden), (b) Score Only (visible preoperative AKI risk probability with passive KDIGO bundle recommendation), or (c) Score + BPA (visible risk plus interruptive KDIGO prompt for high-risk patients).
CRNAs/residents follow their attending' s assignment.
Adult inpatients (age ≥18) with expected overnight stay and eGFR ≥15 mL/min/1.73
m² are included; obstetrics, chronic dialysis, and kidney transplant patients are excluded.
The underlying preoperative model was prospectively validated at UCSF and outperforms anesthesiologist risk estimation reported in the literature.
The model was reviewed and approved by the AI Oversight Committee at UCSF.
Primary endpoint is the continuous change in serum creatinine (mg/dL) from baseline to POD 1-2.
Secondary outcomes include KDIGO-defined AKI, adherence to bundle elements (hemodynamics, balanced fluids, nephrotoxin avoidance, glycemic control), intraoperative hypotension time, fluid volumes, nephrotoxin exposure, perioperative hyperglycemia, length of stay, unplanned ICU transfer, readmission, dialysis, and in-hospital mortality.
Data are obtained from the EHR; analysts are blinded.
No direct subject interaction is planned; the investigators will request a waiver of patient consent.
The study aims to demonstrate that ML-enabled, workflow-embedded decision support can safely and feasibly improve guideline concordant care and decrease early postoperative kidney injury.
Aperçu de l'étude
Statut
Pas encore de recrutement
Les conditions
Intervention / Traitement
Type d'étude
Interventionnel
Inscription (Estimé)
25518
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Coordonnées de l'étude
- Nom: Andrew Bishara, MD
- Numéro de téléphone: 415-502-5880
- E-mail: andrew.bishara@ucsf.edu
Lieux d'étude
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California
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San Francisco, California, États-Unis, 94158
- University of California, San Francisco
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Oui
La description
Inclusion Criteria:
- Adults ≥18 years undergoing non-obstetric surgery at UCSF.
- Inpatient cases with expected overnight stay.
- Baseline eGFR ≥15 mL/min/1.73 m².
- Managed by an attending anesthesiologist randomized to one of three arms (CRNAs/residents follow attending).
- Data available in the UCSF EHR for risk scoring and outcomes.
Exclusion Criteria:
- Obstetric procedures.
- Chronic dialysis patients.
- Kidney transplant recipients.
- Cases without baseline creatinine/eGFR or missing essential EHR elements needed for scoring/outcomes (operational exclusions).
- Outpatient procedures without expected overnight stay.
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Dépistage
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Aucune intervention: Control Arm
Participants receive usual perioperative care with a placeholder blank display without the machine learning-derived acute kidney injury (AKI) risk score.
The clinical decision support tool remains hidden in the electronic health record, and no alerts or recommendations related to the study are shown.
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Expérimental: Acute Kidney Injury Risk Score Only
A machine learning-derived preoperative AKI risk score is displayed within the electronic health record for high-risk patients.
A passive recommendation indicating that the patient may benefit from a KDIGO-based kidney-protective bundle is provided.
The information is advisory only, and no interruptive alerts are used.
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A non-adaptive, machine learning-based clinical decision support tool integrated into the electronic health record that generates a preoperative probability of acute kidney injury (AKI) using routinely collected patient data.
For patients identified as high risk, the tool displays the risk estimate to anesthesia providers without an accompanying Best Practice Advisory (BPA) recommending consideration of a KDIGO-based kidney-protective bundle.
The intervention is advisory only, does not mandate clinical actions, and is designed to support provider decision-making within the existing clinical workflow.
Autres noms:
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Expérimental: Acute Kidney Injury Risk Score with Best Practice Advisory
The machine learning-derived AKI risk score is displayed within the electronic health record for high-risk patients, accompanied by an interruptive Best Practice Advisory (BPA) that notifies providers that the patient may benefit from a KDIGO-based kidney-protective bundle.
The alert is advisory only and does not mandate clinical actions.
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A non-adaptive, machine learning-based clinical decision support tool integrated into the electronic health record that generates a preoperative probability of acute kidney injury (AKI) using routinely collected patient data.
For patients identified as high risk, the tool displays the risk estimate to anesthesia providers with an accompanying Best Practice Advisory (BPA) recommending consideration of a KDIGO-based kidney-protective bundle.
The intervention is advisory only, does not mandate clinical actions, and is designed to support provider decision-making within the existing clinical workflow.
Autres noms:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Post-operative Change in Creatinine
Délai: From pre-operative baseline to 1-2 days post-operative level
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Maximum continuous change in serum creatinine (mg/dL) from baseline to post-operative day 1-2
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From pre-operative baseline to 1-2 days post-operative level
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Acute Kidney Injury
Délai: Operation to Post-operative Day 7
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Acute Kidney Injury as defined by KDIGO
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Operation to Post-operative Day 7
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KDIGO Bundle Adherence
Délai: Intra-operative
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Measurement of provider adherence to KDIGO components
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Intra-operative
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Intra-Operative Time and Severity of Hypotension
Délai: Intra-operative
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Intra-Operative Time and Severity (meaning how far below the threshold) where patient is in hypotension, defined as systolic blood pressure <90 mmHg and mean arterial pressure <65 mmHg during surgery
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Intra-operative
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Total intra-operative intravenous fluid volume administered (mL)
Délai: Intra-operative
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Provider administration of intravenous fluids during the intra-operative period, measured in milliliters (mL).
Intravenous fluids include normal saline, lactated Ringer's, Plasma-Lyte, other balanced crystalloids, and colloid solutions such as albumin.
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Intra-operative
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Length of Stay
Délai: Operation to Post-operative Day 180
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Duration of patient admission in hospital in days
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Operation to Post-operative Day 180
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Intra-operative Hyperglycemic Events
Délai: Intra-operative
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Number of intra-operative hyperglycemic events, defined as the number of recorded blood glucose measurements exceeding 180 mg/dL.
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Intra-operative
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Intra-operative Nephrotoxin Exposure
Délai: Intra-operative
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Number of nephrotoxic medications administered intra-operatively and duration of intra-operative exposure
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Intra-operative
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In-Hospital Mortality
Délai: Operation to Post-operative Day 180
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Patient death while admitted in the hospital
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Operation to Post-operative Day 180
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ICU Transfer and total time in the ICU
Délai: Postoperative
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Any transfers to the ICU while admitted and the total time the patient spends in the ICU
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Postoperative
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Hospital Readmission
Délai: Operation to Post-operative Day 180
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Readmission back to a UCSF hospital following operation
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Operation to Post-operative Day 180
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Dialysis Requirement
Délai: Operation to Post-operative Day 180
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Patients requiring dialysis following surgery
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Operation to Post-operative Day 180
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Dilution Corrected KDIGO AKI measurement (Stage 1 or higher)
Délai: AKI is defined per KDIGO as corrected creatinine increase ≥0.3 mg/dL within 48 hours or ≥1.5× baseline within 7 days. This measure captures "hidden AKI" - kidney injury masked by fluid dilution that would be missed using standard uncorrected creatinine.
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Acute kidney injury (AKI) assessed using KDIGO creatinine criteria applied to dilution-corrected postoperative serum creatinine. Creatinine is corrected for hemodilution from perioperative fluid retention using the formula: Corrected Creatinine (mg/dL) = Measured Creatinine × (1 + Net Fluid Balance / Total Body Water) Where:
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AKI is defined per KDIGO as corrected creatinine increase ≥0.3 mg/dL within 48 hours or ≥1.5× baseline within 7 days. This measure captures "hidden AKI" - kidney injury masked by fluid dilution that would be missed using standard uncorrected creatinine.
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Total intra-operative packed red blood cells administered (units transfused)
Délai: intraoperative
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Provider administration of packed red blood cells during the intra-operative period, measured as total units transfused.
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intraoperative
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Total intra-operative fresh frozen plasma administered (units transfused)
Délai: intraoperative
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Provider administration of fresh frozen plasma during the intra-operative period, measured as total units transfused.
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intraoperative
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Total intra-operative platelets administered (units transfused)
Délai: intraoperative
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Provider administration of platelets during the intra-operative period, measured as total units transfused.
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intraoperative
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Total intra-operative cryoprecipitate administered (units transfused)
Délai: intraoperative
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Provider administration of cryoprecipitate during the intra-operative period, measured as total units transfused.
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intraoperative
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Andrew Bishara, MD, University of California, San Francisco
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013 Sep;119(3):507-15. doi: 10.1097/ALN.0b013e3182a10e26.
- Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015 Sep;123(3):515-23. doi: 10.1097/ALN.0000000000000765.
- Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84. doi: 10.1159/000339789. Epub 2012 Aug 7. No abstract available.
- Kork F, Balzer F, Spies CD, Wernecke KD, Ginde AA, Jankowski J, Eltzschig HK. Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients. Anesthesiology. 2015 Dec;123(6):1301-11. doi: 10.1097/ALN.0000000000000891.
- Zarbock A, Kullmar M, Ostermann M, Lucchese G, Baig K, Cennamo A, Rajani R, McCorkell S, Arndt C, Wulf H, Irqsusi M, Monaco F, Di Prima AL, Garcia Alvarez M, Italiano S, Miralles Bagan J, Kunst G, Nair S, L'Acqua C, Hoste E, Vandenberghe W, Honore PM, Kellum JA, Forni LG, Grieshaber P, Massoth C, Weiss R, Gerss J, Wempe C, Meersch M. Prevention of Cardiac Surgery-Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial. Anesth Analg. 2021 Aug 1;133(2):292-302. doi: 10.1213/ANE.0000000000005458.
- James MT, Dixon E, Tan Z, Mathura P, Datta I, Lall RN, Landry J, Minty EP, Samis GA, Winkelaar GB, Pannu N. Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units. Kidney Int Rep. 2024 Jul 31;9(10):2996-3005. doi: 10.1016/j.ekir.2024.07.025. eCollection 2024 Oct.
- Fujii T, Takakura M, Taniguchi T, Tamura T, Nishiwaki K. Intraoperative hypotension affects postoperative acute kidney injury depending on the invasiveness of abdominal surgery: A retrospective cohort study. Medicine (Baltimore). 2023 Dec 1;102(48):e36465. doi: 10.1097/MD.0000000000036465.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude (Estimé)
15 octobre 2026
Achèvement primaire (Estimé)
15 octobre 2027
Achèvement de l'étude (Estimé)
15 décembre 2027
Dates d'inscription aux études
Première soumission
9 avril 2026
Première soumission répondant aux critères de contrôle qualité
19 mai 2026
Première publication (Réel)
22 mai 2026
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
22 mai 2026
Dernière mise à jour soumise répondant aux critères de contrôle qualité
19 mai 2026
Dernière vérification
1 mai 2026
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 22-37005
- K23GM151611-03 (Subvention/contrat des NIH des États-Unis)
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
NON
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
Non
Étudie un produit d'appareil réglementé par la FDA américaine
Oui
produit fabriqué et exporté des États-Unis.
Oui
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