Real-Time Acute Kidney Injury Perioperative Prediction Clinical Trial (ML-AKI)
19. mai 2026 oppdatert av: 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.
Studieoversikt
Status
Har ikke rekruttert ennå
Intervensjon / Behandling
Studietype
Intervensjonell
Registrering (Antatt)
25518
Fase
- Ikke aktuelt
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiekontakt
- Navn: Andrew Bishara, MD
- Telefonnummer: 415-502-5880
- E-post: andrew.bishara@ucsf.edu
Studiesteder
-
-
California
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San Francisco, California, Forente stater, 94158
- University of California, San Francisco
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-
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Ja
Beskrivelse
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.
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Screening
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
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Ingen inngripen: 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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Eksperimentell: 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.
|
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.
Andre navn:
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Eksperimentell: 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.
|
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.
Andre navn:
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Post-operative Change in Creatinine
Tidsramme: 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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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Acute Kidney Injury
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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)
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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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Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Andrew Bishara, MD, University of California, San Francisco
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Generelle publikasjoner
- 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.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Antatt)
15. oktober 2026
Primær fullføring (Antatt)
15. oktober 2027
Studiet fullført (Antatt)
15. desember 2027
Datoer for studieregistrering
Først innsendt
9. april 2026
Først innsendt som oppfylte QC-kriteriene
19. mai 2026
Først lagt ut (Faktiske)
22. mai 2026
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
22. mai 2026
Siste oppdatering sendt inn som oppfylte QC-kriteriene
19. mai 2026
Sist bekreftet
1. mai 2026
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- 22-37005
- K23GM151611-03 (U.S. NIH-stipend/kontrakt)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
NEI
Legemiddel- og utstyrsinformasjon, studiedokumenter
Studerer et amerikansk FDA-regulert medikamentprodukt
Nei
Studerer et amerikansk FDA-regulert enhetsprodukt
Ja
produkt produsert i og eksportert fra USA
Ja
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