Post-Discharge Nephrology Follow-up for Improved Outcomes

出院后肾脏病学随访以改善结果

• 批准号: 10451808
• 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
• 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/10451808
• 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 control; 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; injury and repair; innovation; insight; interdisciplinary approach; medication safety; mortality; mortality risk; nephrotoxicity; pilot trial; precision medicine; primary outcome; prognostication; randomized trial; recruit; research clinical testing; research study; satisfaction; screening; standard of care; translational scientist; treatment as usual; trend; trial comparing

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.

项目概要/摘要 急性肾损伤 (AKI) 是一种常见并发症，大约 20% 的成年患者在 住院治疗。 AKI 与长期不良后果相关，包括心血管疾病和 死亡，以及慢性肾病（CKD）。尽管血清肌酐可能会在治疗后改善或正常化 AKI 发作后，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结果。事实上，早期的后 严重 AKI 后由肾脏科医生进行出院随访可使死亡率降低 25% 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 在专门的过渡期中对院内 AKI 患者进行系统的出院后肾病随访 急性肾损伤（TCC-AKI）后的护理诊所并将其与护理标准进行比较。理由是 出院后的头几个月是医疗干预的关键时期 可能对长期肾脏结局产生重大影响。这种干预措施将包括远程医疗或 肾病专家将在现场访问中解决患者护理的几个关键领域，这些领域可能会影响长期 长期临床结果，包括血压管理、药物协调、心血管健康 评估和患者咨询。我们将强调适当的护理管理目标 共病危险因素。总体假设是 TCC-AKI 后的及时纵向随访 KDIGO 2 期和 3 期 AKI 患者出院将导致中期和长期临床改善 与常规护理相比，效果更好，患者报告的效果也更好。总体目标将是 通过追求 3 个具体目标来实现：1) 招募 KDIGO 2 期和 3 期 AKI 患者 住院接受出院后 AKI 随访的随机临床试验； 2）确定中间体 与接受常规护理的患者相比，接受出院后 AKI 随访的患者的结局； 3) 至 与接受常规护理的患者相比，确定出院后 AKI 随访的长期结果。在下面 目标 1，将招募患者参加本研究，以便在 TCC-AKI 中随机进行系统性 AKI 随访。 在目标 2 下，将评估中期结果，包括复发性 AKI 和住院治疗。瞄准下 3、将评估长期结局，包括 CKD 发病率、CKD 进展和死亡率。这 这里提出的研究因其多学科方法、尖端技术的使用而具有创新性， 将远程医疗整合到临床，并开发出院后 AKI 的系统方法 后续行动。这项工作意义重大，因为严格进行了随机研究和转化 需要进行研究来评估出院后 AKI 随访对广泛临床的疗效 通过提供对系统性肾病治疗有效性的深入见解，使用并将推进动态肾脏病护理 出院后 AKI 随访。