Post-Discharge Nephrology Follow-up for Improved Outcomes

出院后肾脏病学随访以改善结果

基本信息

批准号：
10296363
负责人：
Chirag R Parikh
金额：
$ 66.67万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-19 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10296363
关键词：
Acute Renal Failure with Renal Papillary Necrosis Address Adult Algorithms Angiotensin Receptor Angiotensin-Converting Enzyme Inhibitors Biological Markers Biological Process Blood Blood Pressure Cardiovascular Diseases Cardiovascular system Caring Cessation of life Chronic Kidney Failure Clinic Clinical Clinical Investigator Complication Consent Counseling Creatinine Development Disease Progression Effectiveness Electronic Health Record Eligibility Determination Enrollment Evaluation Event Fibrosis Funding Glomerular Filtration Rate Goals Health Hospital Mortality Hospitalization Hospitals Incidence Inflammation Intervention Kidney Kidney Diseases Link Measurement Medical Medical Research Mission Modification Multi-Institutional Clinical Trial National Institute of Diabetes and Digestive and Kidney Diseases Nephrology Outcome Patient Care Patient Outcomes Assessments Patient Recruitments Patients Perioperative Persons Pharmaceutical Preparations Phenotype Public Health Quality of life Randomized Randomized Clinical Trials Recovery Recurrence Renal function Research Research Personnel Risk Risk Factors Serum Site Survivors Syndrome System Techniques Telemedicine Time Translational Research Trauma Urine Visit Work adverse outcome blood pressure regulation cardiovascular health cardiovascular risk factor clinical care comorbidity diabetes control efficacy evaluation evidence base experience follow-up health assessment hospital readmission improved improved outcome inhibitor/antagonist injury and repair innovation insight interdisciplinary approach medication safety mortality mortality risk nephrotoxicity pilot trial precision medicine primary outcome prognostic randomized trial recruit research clinical testing research study satisfaction screening standard of care translational scientist treatment as usual trend trial comparing

项目摘要

PROJECT SUMMARY/ABSTRACT Acute kidney injury (AKI) is a common complication experienced by roughly 20% of adult patients during hospitalization. AKI is associated with long-term adverse outcomes including cardiovascular disease and death, as well as chronic kidney disease (CKD). Although serum creatinine may improve or normalize after an episode of AKI, the biological processes of injury, repair, and fibrosis may continue for months afterwards; thus during this time period, interventions can be implemented to improve long-term outcomes. Indeed, early post- discharge follow-up with a nephrologist after severe AKI has been associated with a 25% reduction in mortality in pilot trials. The overall objective of this multicenter clinical trial is to definitively evaluate the impact of systematic post-discharge nephrology follow-up among patients with in-hospital AKI in a dedicated transitional care clinic after acute kidney injury (TCC-AKI) and compare it with the standard of care. The rationale is that the first few months after hospital discharge represent a critical window of time in which medical interventions may have a significant impact on long-term kidney outcomes. This intervention will consist of telemedicine or in-person visits in which nephrologists will address several key domains of patient care that can influence long- term clinical outcomes, including blood pressure management, medication reconciliation, cardiovascular health assessment, and patient counseling. We will emphasize appropriate care management targets for several comorbid risk factors. The overarching hypothesis is that timely longitudinal follow-up at the TCC-AKI post- discharge in patients with KDIGO Stages 2 and 3 AKI will result in improved intermediate and long-term clinical outcomes compared to usual care, with better patient-reported outcomes as well. The overall objective will be achieved by pursuing 3 specific aims: 1) to recruit patients with KDIGO stages 2 and 3 AKI during hospitalization to a randomized clinical trial of post-discharge AKI follow-up; 2) to ascertain intermediate outcomes in patients receiving post-discharge AKI follow-up compared to those receiving usual care; and 3) to ascertain long-term outcomes of post-discharge AKI follow-up compared to those receiving usual care. Under Aim 1, patients will be recruited into this study for randomization to systematic AKI follow-up in a TCC-AKI. Under Aim 2, intermediate outcomes, including recurrent AKI and hospitalizations will be evaluated. Under Aim 3, long-term outcomes including CKD incidence, CKD progression, and mortality will be assessed. The research proposed here is innovative for its multidisciplinary approach, use of cutting-edge techniques, integration of telemedicine for clinical use, and development of a systematic approach to post-discharge AKI follow-up. This work will be significant because rigorously conducted randomized studies and translational research studies are needed to evaluate the efficacy of post-discharge AKI follow-up for widespread clinical use and will advance ambulatory nephrology care by providing insights into the effectiveness of systematic post-discharge AKI follow-up.

项目摘要/摘要急性肾脏损伤（AKI）是大约20％的成年患者经历的常见并发症住院。 AKI与长期不良后果有关，包括心血管疾病和死亡以及慢性肾脏疾病（CKD）。尽管血清肌酐可能会改善或在 AKI发作，损伤，修复和纤维化的生物学过程可能会持续数月。因此在此期间，可以实施干预措施以改善长期结果。确实，早期严重AKI后，肾脏科医生的出院随访与死亡率降低25％有关在试点试验中。这项多中心临床试验的总体目标是确定评估在专用过渡中，有系统的后肾脏后肾脏病随访急性肾脏损伤（TCC-AKI）后的护理诊所，并将其与护理标准进行比较。理由是住院后的头几个月代表了医疗干预的关键时间窗口可能会对长期肾脏结局产生重大影响。此干预将包括远程医疗或面对面的访问，肾脏科医生将解决一些可能影响长期的患者护理的关键领域术语临床结果，包括血压管理，药物对帐，心血管健康评估和患者咨询。我们将强调一些适当的护理管理目标合并风险因素。总体假设是，在TCC-Aki后的及时纵向随访 Kdigo阶段2和3 AKI患者的出院将导致中间和长期临床的改善与通常的护理相比，结果也有更好的患者报告结果。总体目标将是通过追求3个具体目标来实现：1）在招募KDIGO阶段2和3 AKI的患者住院治疗AKI后临时随访的随机临床试验； 2）确定中间与接受常规护理的患者相比，接受了入院后AKI随访的患者的结果；和3）到与接受常规护理的人相比，确定了入院后AKI随访的长期结局。在下面 AIM 1，将招募患者参加这项研究，以随机分配到TCC-AKI中的系统性AKI随访。在AIM 2下，将评估包括复发性AKI在内的中级结果和住院。在目标下 3，将评估包括CKD发病率，CKD进展和死亡率在内的长期结局。这此处提出的研究对于其多学科方法，尖端技术的使用是创新的，远程医疗用于临床用途，并开发系统过电气后AKI 后续。这项工作将是重要的，因为严格进行了随机研究和翻译需要研究以评估病后AKI随访的疗效，用于广泛的临床使用并将通过提供有关系统性有效性的见解来提高卧床肾脏病的护理放电后AKI随访。