Abstract: TH-PO051
Multidisciplinary Care Improves Follow-Up for AKI Survivors
Session Information
- AKI: Biomarkers, Risk Factors, Treatments, Outcomes
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical‚ Outcomes‚ and Trials
Authors
- May, Heather P., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Schreier, Diana J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Herges, Joseph, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Kattah, Andrea G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- McCoy, Rozalina G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Anderson, Brenda K., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Meade, Laurie A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Tinaglia, Angeliki G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Mara, Kristin C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Barreto, Erin F., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Group or Team Name
- The ACT Study Group
Background
Innovative models are needed to address significant gaps in kidney care follow-up for AKI survivors.
Methods
The AKI in Care Transitions (ACT) pilot included adults with stage 3 AKI, discharged to home without dialysis. ACT included pre-discharge education and care coordination and post-discharge follow-up in primary care with a clinician and pharmacist within 14 days (Figure 1). ACT was implemented in phases (Usual Care, Education, ACT) for group comparisons. The primary outcome was feasibility, measured by the proportion of participants who received the phase-appropriate intervention components. Secondary outcomes at 14 and 30 days were compared across groups using the Fisher’s exact or Kruskal-Wallis tests.
Results
46 of 110 (42%) eligible adults were enrolled (Table 1). Education was completed in 18/18 and 14/15 participants in the Education and ACT groups, respectively. The cumulative incidence of provider and laboratory follow-up at 14 and 30 days was significantly different across groups [14 days: Usual care 0%, Education 11%, ACT 73% (p<0.01); 30 days: 0%, 22%, and 73% (p<0.01)].
Conclusion
Multidisciplinary post-AKI care improved timely laboratory and provider follow-up in the primary care setting. This was driven by compliance with best-practice recommendations for urine protein evaluation, a key indicator of prognosis and therapeutic needs.
Table 1. Select Participant Data, Outcomes
| Usual Care (N=13) | Education (N=18) | ACT (N=15) | P-Value | |
| Characteristics | ||||
| Chronic kidney disease | 6 (46) | 11 (61) | 6 (40) | - |
| Dialysis during hospitalization | 0 | 4 (22) | 2 (15) | - |
| Dismissal eGFR (ml/min/1.73m2) | 40 (16, 58) | 29 (19, 54) | 31 (16, 58) | - |
| Process, Clinical Outcomes | ||||
| 30-day serum creatinine | 11 (85) | 14 (78) | 14 (93) | 0.52 |
| 30-day urine protein | 2 (15) | 5 (28) | 13 (87) | <0.001 |
| Days to first urine protein | 35 (28,78) | 20 (7, 52) | 5.5 (2, 9) | 0.001 |
| 30-day primary care follow-up | 12 (92) | 11 (61) | 12 (80) | 0.12 |
| 30-day nephrology follow-up | 1 (8) | 3 (17) | 5 (33) | 0.22 |
| 30-day readmission | 3 (23) | 8 (44) | 2 (13) | 0.13 |
N(%); median(IQR)
Figure 1. Study Design
Funding
- NIDDK Support