Early nephrologist involvement in hospital-acquired XXXX : a pilot study.

@entity1 @entity8 @entity810 @entity1011
BACKGROUND: The optimal timing of nephrology consultation in @entity1 with hospital-acquired @entity810 ( @entity810 ) is unknown. STUDY DESIGN: Prospective controlled nonrandomized intervention study. SETTING _ @entity1 : We screened daily serum @entity1011 (SCr) levels of 4,296 @entity1 admitted to the St. Louis Veterans Affairs Medical Center between September and November 2008 (control group) and January to May 2009 (intervention group). 354 @entity1 (8.2%) met the definition of in-hospital @entity810 (SCr level increase of 0.3 mg/dL over 48 hours); 176 of whom met all inclusion criteria; 85 and 91 @entity1 were enrolled in the control (standard care) and intervention groups, respectively. INTERVENTION: Early renal service involvement (EARLI), defined as a 1-time nephrology consultation within 18 hours of the onset of @entity810 . OUTCOME: Primary outcome defined as 2.5-fold increase in SCr level from admission. MEASUREMENT: Daily SCr until discharge. RESULTS: The 2 groups had similar characteristics at baseline and at the time of @entity810 . The intervention was completed at a mean of 13.1    0.8 hours from the onset of @entity810 . Nephrology recommendations in the EARLI group included specific diagnostic, therapeutic, and preventative components. The primary outcome occurred in 12.9% of @entity1 in the control group compared with 3.3% of @entity1 in the EARLI group (P = 0.02). @entity1 in the EARLI group had a lower peak SCr level of 1.8    0.1 versus 2.1    0.2 mg/dL in controls (P = 0.01). LIMITATIONS: Single-center nonrandomized study of mostly US male veterans. CONCLUSIONS: Early nephrologist involvement in @entity1 with @entity810 may reduce the risk of a further @entity8 . A larger randomized trial is needed to confirm the findings.
