Identifying opportunities to lower rates of AKI and improve outcomes

寻找降低 AKI 发生率和改善预后的机会

• 批准号: 9306837
• 负责人: Alan S Go
• 金额: $ 51.88万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9306837
• 关键词: Accident and Emergency department; Acute; Acute Renal Failure with Renal Papillary Necrosis; Acute myocardial infarction; Age Distribution; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Calendar; California; Caring; Cessation of life; Characteristics; Chronic Kidney Failure; Clinic; Clinical; Code; Communities; Computerized Medical Record; Data; Data Set; Death Rate; Detection; Diagnosis; Disease; Drops; Epidemiology; Goals; Healthcare Systems; Hospitalization; Hospitals; Incidence; Individual; Infection; Integrated Delivery of Health Care; Intervention; Intestines; Kidney; Knowledge; Laboratories; Lead; Link; Measures; Medical; Morbidity - disease rate; Outcome; Patient risk; Patients; Pattern; Pharmaceutical Preparations; Physicians; Process; Recurrence; Renal function; Research; Risk; Risk Factors; Sepsis; Testing; Time; United States; Variant; Vulnerable Populations; care systems; clinical care; community setting; cost; effective therapy; falls; follow-up; high risk; improved; improved outcome; member; modifiable risk; mortality; older patient; prevent; public health relevance; urgent care

DESCRIPTION (provided by applicant): Acute kidney injury (AKI), an abrupt decline in kidney function, is a common and important problem among hospitalized patients. AKI is associated with significant short and long-term morbidity and mortality. Recent data suggest that the incidence of hospitalized AKI is on the rise nationally. Care for AKI is entirely supportive as there are no effective treatments currently. Thus, identifying opportunities to prevent AKI from developing in the first place is critically important. We have compelling preliminary data from Kaiser Permanente Northern California (a large integrated health care delivery system caring for ~3.3 million people) showing a reversal of the rising incidence of hospitalized AKI so that the incidence is now declining. In the proposed project, we will test the hypotheses that the declining AKI incidence correlates with temporal changes in medical practice such as reduced use of nephrotoxins (Aim 1). We will test the hypothesis that more cases of AKI identified in acute- care settings (e.g., emergency department and urgent care clinic) are being managed in the community setting; we describe these cases as "community-acquired, community managed AKI" (Aim 2). Finally, we will determine medical practices and patient characteristics associated with recurrent AKI, which contributes to both higher disease incidence as well as cumulative detrimental effects (Aim 3). Our research team has substantial expertise developing and analyzing datasets that comprehensively capture details of clinical care delivered and precise clinical outcomes among Kaiser Permanente members. The large scale of these datasets, along with the granular, linked individual-level hospitalization and ambulatory data available to us from the Kaiser Permanente electronic medical record, are particular strengths of our proposed approach. The findings generated by this research will not only fill important knowledge gaps in the contemporary epidemiology of AKI (including community-acquired, community-managed AKI and recurrent AKI) but will identify opportunities to reduce the risk of developing AKI. Since care of AKI is entirely supportive at present, if the drop in the incidence of AKI is associated wih specific changes in medical practice patterns, these can be prioritized for testing and implementation on a widespread basis across the United States. A nationwide reduction in the incidence of AKI would have direct and important benefits to both patients and the health care system.

描述（由申请人提供）：急性肾损伤（阿基）是肾功能的突然下降，是住院患者中常见的重要问题。阿基与显著的短期和长期发病率和死亡率相关。最近的数据表明，住院阿基的发病率在全国范围内呈上升趋势。阿基的护理是完全支持的，因为目前没有有效的治疗方法。因此，首先确定预防阿基发展的机会至关重要。我们从Kaiser Permanente北方加州（一个大型综合医疗保健提供系统，为约330万人提供服务）获得了令人信服的初步数据，显示住院阿基发病率的上升趋势发生逆转，因此发病率现在正在下降。在拟议的项目中，我们将检验阿基发病率下降与医疗实践中的时间变化相关的假设，例如减少肾毒素的使用（目标1）。我们将检验以下假设：在急性护理环境中发现的阿基病例更多（例如，急诊科和紧急护理诊所）在社区环境中进行管理;我们将这些病例描述为“社区获得性、社区管理的阿基”（目标2）。最后，我们将确定与复发性阿基相关的医疗实践和患者特征，这有助于提高疾病发病率以及累积有害影响（目标3）。我们的研究团队拥有丰富的专业知识，开发和分析数据集，全面捕捉Kaiser Permanente成员提供的临床护理细节和精确的临床结果。这些数据集的规模庞大，沿着而来的是我们可以从 KaiserPermanente电子医疗记录是我们提出方法的特别优势。这项研究产生的结果不仅将填补阿基（包括社区获得性、社区管理的阿基和复发性阿基）当代流行病学的重要知识空白，而且将确定降低发生阿基风险的机会。由于目前阿基的治疗完全是支持性的，如果阿基发病率的下降与医疗实践模式的特定变化有关，则可以优先在美国各地广泛进行测试和实施。在全国范围内降低阿基的发病率将对患者和医疗保健系统产生直接和重要的益处。

项目成果

Acute kidney injury: Clinical trials in AKI: is the end in sight?

急性肾损伤：AKI 临床试验：终点在望吗？

• DOI: 10.1038/nrneph.2016.35
• 发表时间: 2016
• 期刊: Nature reviews. Nephrology
• 作者: Parks,Monica;Liu,KathleenD
• 通讯作者: Liu,KathleenD