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

急性肾损伤(AKI)是一个巨大的公共卫生问题，影响多达20%的住院患者， 它与发病率和死亡率密切相关，并带来很高的经济损失。没有任何地方比这更 比美国东南部明显，那里受肾脏疾病和其他疾病的影响更大 并发症。AKI是慢性肾脏疾病(CKD)、心血管疾病的重要危险因素 健康相关生活质量、再住院和出院后死亡。提高产品质量 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 将肾脏疾病和其他利益相关者视为降低这些长期风险的关键机会 并发症。尽管强调了这一点，AKI幸存者的护理往往很差和零散，患者面临着 系统和个人层面的障碍都阻碍了最佳护理。这些问题包括很难获得针对肾病的专科治疗。 护理要素，如监测肾功能以恢复或复发AKI，危险因素识别和 对肾脏疾病进展、药物调节和避免肾毒素的修改，使用 肾脏和心脏保护药物，以及适当的患者和照顾者教育。此外，还有许多 患者还经历了生活质量差和其他护理障碍，包括沉重的症状负担和 疲劳、行动不便、交通工具减少或错过工作的能力可能会进一步限制 全身心投入到护理中。该应用程序将执行一项随机临床试验，旨在检查 通过远程医疗提供的远程干预可以克服这些障碍，减少临床并发症 并改善中重度出院患者的健康相关生活质量 阿琪。两项干预措施将在出院后的90天内进行测试。第一次干预 是一个“住院后AKI护理包”，旨在优化包括肾脏健康监测在内的护理。 药物安全性审查和协调、患者和照顾者教育以及确定可修改的 肾功能进一步丧失的危险因素。第二种干预是以认知行为为基础的体力活动 治疗(CBPT)，一种将自我指导锻炼与认知行为相结合的新型家庭干预 可以减少患者对症状的感知并提高参与度和功能状态的策略。 我们将测试这些干预措施在AKI后改善临床结果的能力，例如 90天后再住院/急诊室就诊、AKI复发、死亡和肾功能。我们还将 评估与健康相关的生活质量和症状负担。之后，患者将接受长达12个月的随访 登记以检查这些干预措施的长期影响。这项研究将在范德比尔特进行 大学医学中心(PiSiew)和阿拉巴马大学伯明翰大学(MPI Gutierrez)，两位学者 东南部的医疗中心拥有多样化的患者群体和强大的基础设施，以支持 建议护理急性肾损伤后门诊病人(COPE-AKI)的工作和目标。

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.