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

急性肾损伤（阿基）是一个巨大的公共卫生问题，影响高达20%的住院患者， 与发病率和死亡率密切相关，并带来高昂的经济损失。没有比这更 这一点比美国东南部明显，那里受肾脏疾病及其疾病的影响不成比例 并发症阿基是慢性肾脏疾病（CKD）、心血管疾病、不良反应和高血压的重要危险因素。 健康相关生活质量（HRQoL）、再住院和出院后死亡。提高 住院后的护理质量得到了国家糖尿病和消化研究所的认可 肾脏疾病和其他利益相关者作为一个关键的机会，以减少这些长期的风险， 并发症尽管如此，对阿基幸存者的护理往往很差，而且支离破碎， 系统和个人层面的障碍，以最佳的照顾。这些包括肾脏病专用的 护理要素，如监测肾功能以恢复或复发阿基，风险因素识别， 针对肾脏疾病进展的调整、药物调节和避免肾毒素， 肾脏和心脏保护药物，以及适当的患者和护理人员教育。另外很多 患者还经历生活质量差和其他护理障碍，包括沉重的症状负担， 疲劳、行动不便、交通不便或无法上班，这些都可能进一步限制 参与护理。本申请将进行一项随机临床试验，旨在检查是否有两个 通过远程保健远程提供的干预措施可以克服这些障碍，减少临床并发症 并改善中度至重度患者出院后的健康相关生活质量 阿基两种干预措施将在出院后的90天内进行测试。第一次以 是一个“住院后阿基护理包”，旨在优化护理，包括监测肾脏健康， 药物安全性审查和协调，患者和护理人员教育，以及确定可修改的 肾功能进一步丧失的危险因素。第二种干预是基于认知行为的物理干预， 治疗（CBPT），一种新的家庭为基础的干预，夫妇自我导向的运动与认知行为 可以减少患者对症状的感知并改善参与和功能状态的策略。 我们将测试这些干预措施改善阿基后临床结局的能力，例如 再住院/急诊室就诊、复发性阿基、死亡和90天时的肾功能。我们还将 评估健康相关的生活质量和症状负担。患者将接受长达12个月的随访， 研究这些干预措施的长期影响。本研究将在范德比尔特进行 大学医学中心（PI Siew）和亚拉巴马伯明翰大学（MPI Gutierrez），两个学术 东南部的医疗中心拥有多样化的患者人群和强大的基础设施， 急性肾损伤后门诊患者护理（COPE-AKI）联盟的拟议工作和目标。

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.