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: 10670199
• 负责人: Chirag R Parikh
• 金额: $ 64.76万
• 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/10670199
• 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; Dedications; Development; Disease Progression; Effectiveness; Eligibility Determination; Enzyme Inhibitor Drugs; Evaluation; Event; Fibrosis; Funding; Glomerular Filtration Rate; Goals; Health; Hospital Mortality; Hospitalization; Hospitals; Incidence; Inflammation; Injury; Intervention; Kidney; Kidney Diseases; Link; Managed Care; Measurement; Medical; Medical Research; Mission; Modification; Multi-Institutional Clinical Trial; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Outcome; Patient Admission; Patient Care; Patient Outcomes Assessments; Patient Recruitments; Patients; Perioperative; Persons; Pharmaceutical Preparations; Phenotype; Public Health; Quality of life; Randomized; Recovery; Recurrence; Renal function; Research; Research Personnel; Risk; Risk Factors; Serum; Site; Survivors; Syndrome; 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; electronic health record system; evidence base; experience; follow-up; health assessment; hospital readmission; improved; improved outcome; innovation; insight; interdisciplinary approach; medication safety; mortality; mortality risk; nephrotoxicity; participant enrollment; pilot trial; precision medicine; primary outcome; prognostication; randomized trial; randomized, clinical trials; recruit; repaired; 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.

项目总结/文摘