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

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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.