The Southeastern Acute Kidney Injury (SEAK) Alliance for the COPE-AKI Consortium

COPE-AKI 联盟东南部急性肾损伤 (SEAK) 联盟

• 批准号: 10451665
• 负责人: Javier A. Neyra
• 金额: $ 66.67万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 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/10451665
• 关键词: Academic Medical Centers; Acute Renal Failure with Renal Papillary Necrosis; Address; Adult; Affect; Alabama; Albuminuria; Aldosterone Antagonists; Ambulatory Care; Angiotensins; Attention; Behavioral; Blood Pressure; Cardiovascular Diseases; Caring; Catchment Area; Cessation of life; Chronic Kidney Failure; Clinic Visits; Clinical; Clinical Trials Design; Cognitive; Collaborations; Complication; Country; Couples; Creatinine; Data; Dialysis procedure; Disease Progression; Dose; Electronic Health Record; Elements; Emergency department visit; Enrollment; Ensure; Ethics; Event; Exercise; Face; Fatigue; Glomerular Filtration Rate; Goals; Health; Heart failure; Home; Hospitalization; Hospitals; Human; Incidence; Individual; Infrastructure; Intervention; Investments; Kidney; Kidney Diseases; Life; Longitudinal Studies; Measures; Medical center; Medicine; Mental Depression; Minority Groups; Modification; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Outcome; Patient Care; Patient Education; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmaceutical Preparations; Physical activity; Physical therapy; Population; Population Heterogeneity; Principal Investigator; Process; Proteinuria; Public Health; Quality of Care; Quality of life; Randomized; Randomized Clinical Trials; Recovery; Recovery of Function; Recurrence; Renal function; Renin; Research; Risk; Risk Factors; SF-36; Self-Direction; Serum; Survivors; Symptoms; Telephone; Testing; Time; United States National Institutes of Health; Universities; Work; acute care; barrier to care; base; cardioprotection; caregiver education; clinical center; design; disadvantaged population; experience; follow-up; functional status; health related quality of life; high risk population; hospital readmission; improved; improved outcome; injury recovery; innovation; medication safety; modifiable risk; mortality; motivational enhancement therapy; multi-component intervention; nephrotoxicity; novel; novel strategies; palliative; patient engagement; patient population; posthospitalization care; primary endpoint; primary outcome; recruit; remote delivery; response; secondary analysis; secondary endpoint; secondary outcome; skills; socioeconomics; success; symposium; telehealth; transportation access; treatment as usual

Acute kidney injury (AKI) is an enormous public health problem that affects up to 20% of hospitalized patients, is strongly associated with morbidity and mortality, and carries a high financial toll. Nowhere is this more apparent than in the Southeastern US, which is disproportionately affected by kidney disease and its complications. AKI is an important risk factor for chronic kidney disease (CKD), cardiovascular disease, poor health-related quality of life (HRQoL), rehospitalizations, and death after hospital discharge. Improving the quality of care following hospitalization has been recognized by the National Institute of Diabetes and Digestive and Kidney Diseases and other stakeholders as a critical opportunity to reduce the risk for these long-term complications. Despite this emphasis, care of AKI survivors is often poor and fragmented, and patients face both systemic and individual-level barriers to optimal care. These include poor access to nephrology-specific care elements such as monitoring of kidney function for recovery or recurrent AKI, risk factor identification and modification for kidney disease progression, medication reconciliation and nephrotoxin avoidance, use of kidney and cardioprotective medications, and appropriate patient and caregiver education. In addition, many patients also experience poor quality of life and other barriers to care, including a heavy symptom burden and fatigue, limited mobility, reduced access to transportation or ability to miss work that can further limit engagement in care. This application will perform a randomized clinical trial designed to examine whether two interventions delivered remotely via telehealth can overcome these barriers to reduce clinical complications and improve health-related quality of life among patients discharged from the hospital with moderate to severe AKI. Two interventions will be tested over a 90-day period following hospital discharge. The first intervention is a ‘post-hospitalization AKI care bundle’ designed to optimize care that includes monitoring of kidney health, medication safety review and reconciliation, patient and caregiver education, and identification of modifiable risk factors for further loss of kidney function. The second intervention is cognitive-behavioral based physical therapy (CBPT), a novel home-based intervention that couples self-directed exercise with cognitive-behavioral strategies that can reduce patient’s perception of symptoms and improve engagement and functional status. We will test the ability of these interventions to improve clinical outcomes after AKI such as rehospitalizations/emergency room visits, recurrent AKI, death, and kidney function at 90 days. We will also evaluate health-related quality of life and symptom burden. Patients will be followed for up to 12 months after enrollment to examine the longer-term impact of these interventions. The study will be performed at Vanderbilt University Medical Center (PI Siew) and University of Alabama Birmingham (MPI Gutierrez), two academic medical centers in the Southeast with diverse patient populations and robust infrastructures to support the proposed work and objectives of the Caring for Outpatients after Acute Kidney Injury (COPE-AKI) Consortium.

急性肾脏损伤（AKI）是一个巨大的公共卫生问题，影响多达20％的住院患者， 与发病率和死亡率密切相关，并带来巨大的财务损失。没有更多的地方 显而易见的是美国东南部，它受肾脏疾病及其的影响不成比例 并发症。 AKI是慢性肾脏疾病（CKD），心血管疾病，差的重要危险因素 与健康相关的生活质量（HRQOL），住院后的重新住院和死亡。改善 住院后的护理质量已被美国国家糖尿病研究所和消化研究所认可 肾脏疾病和其他利益相关者是降低这些长期风险的关键机会 并发症。尽管这种强调，对Aki冲浪者的照顾通常很差且分散，并且患者面对 最佳护理的系统性和个人级别的障碍。这些包括不良的肾脏学特异性 护理因素，例如监测肾脏功能以恢复或经常性AKI，风险因素识别和 修改肾脏疾病进展，药物对帐和避免肾毒素的改良，使用 肾脏和心脏保护药物，以及适当的患者和护理人员教育。此外，许多 患者的生活质量和其他护理障碍也遭受较差 疲劳，流动性有限，可以降低运输或失去工作能力，这可能会进一步限制 参与护理。该应用将执行一项随机临床试验，旨在检查两个 通过远程医疗远程提供的干预措施可以克服​​这些障碍以减少临床并发症 并改善从医院出院的患者中与健康相关的生活质量 aki。出院后的90天期间，将在90天的时间内进行两项干预措施。第一次干预 是“院后AKI护理捆绑包”，旨在优化护理，包括监测肾脏健康， 药物安全审查与和解，患者和照顾者教育以及可修改的识别 进一步丧失肾功能的风险因素。第二个干预是基于认知行为的身体 治疗（CBPT），一种新型的家庭干预措施，与认知行为的自我锻炼伴侣 可以减少患者对症状并改善参与度和功能状况的策略。 我们将测试这些干预措施在AKI之后改善临床结果的能力 90天后，重新建立/急诊室就诊，反复的AKI，死亡和肾脏功能。我们也会 评估与健康相关的生活质量和症状伯恩。患者将在此后最多12个月 注册以检查这些干预措施的长期影响。该研究将在范德比尔特进行 大学医学中心（PI SIEW）和阿拉巴马大学伯明翰大学（MPI Gutierrez），两个学术 东南部的医疗中心，有潜水员的患者人群和强大的基础设施来支持 急性肾脏受伤（COPE-AKI）财团后，拟议的工作和目标是护理门诊病人。