Post-Discharge Nephrology Follow-up for Improved Outcomes

项目摘要/摘要 急性肾损伤(AKI)是一种常见的并发症，大约20%的成年患者在 住院治疗。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)。尽管经过一段时间后，血清肌酐可能会改善或恢复正常。 AKI发病后，损伤、修复和纤维化的生物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成果。事实上，早期的后- 严重急性肾损伤后肾脏科医生的出院随访与死亡率降低25%相关 在试点试验中。这项多中心临床试验的总体目标是明确评估 专科过渡期间住院AKI患者出院后肾病的系统随访 护理急性肾损伤后门诊(TCC-AKI)，并与护理标准进行比较。理由是 出院后的头几个月是医疗干预的关键时间窗口 可能会对肾脏的长期结局产生重大影响。这一干预措施将包括远程医疗或 肾内科医生将面对面访问，讨论可能影响长期护理的几个关键患者护理领域 长期临床结果，包括血压管理、药物调节、心血管健康 评估和病人咨询。我们将强调以下几个适当的护理管理目标 并存的风险因素。最重要的假设是，在TCC-AKI后进行及时的纵向随访- KDIGO 2期和3期AKI患者的出院将改善中长期临床 结果与常规护理相比，患者报告的结果也更好。总体目标将是 通过追求3个具体目标实现：1)招募KDIGO 2期和3期AKI患者 出院后AKI随访的随机临床试验的住院；2)确定中间体 接受出院后AKI随访的患者与接受常规护理的患者相比的结果；以及3) 确定出院后AKI随访的长期结果与那些接受常规护理的患者相比。在……下面 目的1，将患者纳入这项研究，随机对TCC-AKI患者进行系统的AKI随访。 在目标2下，将评估中期结果，包括复发性急性肾功能衰竭和住院。在AIM下 3、将评估包括CKD发病率、CKD进展和死亡率在内的长期结果。这个 这里提出的研究具有创新性，因为它采用了多学科方法，使用了尖端技术， 临床使用的远程医疗的集成，以及出院后AKI的系统方法的开发 后续行动。这项工作将具有重要意义，因为严格地进行了随机研究和翻译 需要研究来评估出院后AKI对广泛临床的疗效 使用并将通过提供对系统的有效性的洞察力来促进非卧床肾病护理 出院后AKI随访。

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.