Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

We are interested in the comparative effectiveness of patient safety interventions in decreasing the incidence of acute kidney injury (AKI). This includes questions related to interventions focused on reducing drug-drug interactions, inappropriate prescribing of nephrotoxins, inadequate monitoring of potentially nephrotoxic medications, failure to identify AKI risk factors, and inappropriate diagnostic testing (contrast dye).

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Are computerized decision support systems (e.g. identification of patients at risk for nephrotoxicity, drug-age alerts, dosing guidelines, contraindicated medication alerts, alerts to change in renal function that may require medication dose changes) effective in decreasing the incidence of AKI?

Are interventions to increase providers’ awareness of patients at risk for nephrotoxicity effective in decreasing the incidence of AKI?

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

All patients with chronic kidney disease (CKD)

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

We are especially interested in subgroups with higher than normal rates of CKD, such as African-Americans and obese middle-aged and elderly adults.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Prevention of AKI

Describe any health-related risks, side effects, or harms that you are concerned about.

Failure to use a diagnostic test or treatment because of mistaken belief it involves increased risk of AKI

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

AHRQ Priority Populations

• Low income groups
• Minority groups
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

CKD is increasing in the population and is associated with obesity, diabetes. African-Americans, Hispanics, and older adults are disproportionately affected. Patients with CKD are especially vulnerable to drug interactions, treatments, and diagnostic tests (e.g., contrast agents) that involve potential nephrotoxins. At the same time, CKD patients can also lose the benefit of treatments or diagnostic tests that are withheld because of mistaken or excessive fears of kidney damage. Better state of knowledge and guidelines could both prevent unnecessary AKI and allow CKD patients to benefit from safe treatments and tests.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was identified in our AHRQ/EHC sponsored topic identification project. Among a large number of CKD topics, a group of stakeholders ranked this as a high priority topic.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is general recognition that some drugs, treatments, or diagnostic tests involve potential nephrotoxins and should be used with caution, if at all, with patients whose kidneys are already compromised by CKD. However, there may be substantial room for improvement in clinician and patient knowledge. Moreover, there is not sufficient understanding of whether, or exactly how, such interventions might be modified so that CKD patients can still benefit from them.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Answers to the above questions would help inform practice and guidelines for treatments and diagnostic tests used with CKD patients.

Describe the timeframe in which an answer to your question is needed.

We would like to see this in a Topic Development & Triage project very soon.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

CKD is more prevalent among African-Americans, Hispanic-Americans, low income groups, the obese population, and the elderly.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Answers to the above questions would help inform practice and guidelines for treatments and diagnostic tests used with CKD patients.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

We are an AHRQ/EHC EPC