Kidney Week

Abstract: TH-OR13

AKI in Care Transitions (ACT): A Randomized Controlled Feasibility Trial

Session Information

• AKI: New Frontiers in Prognostication and Management
  October 24, 2024 | Location: Room 6C, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Ledet, Caroline B., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Caroline B. Ledet, MD

• May, Heather P., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Heather P. May, MSc, PharmD

• Cole, Kristin C., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Kristin C. Cole, MS

• Griffin, Joan M., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Joan M. Griffin, PhD

• Herges, Joseph, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Joseph Herges, PharmD

• Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Kianoush Kashani, MD, MS, FASN

• Kattah, Andrea G., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Andrea G. Kattah, MD, MS

• Mccoy, Rozalina G., University System of Maryland, Baltimore, Maryland, United States

Rozalina G. Mccoy, MD, MS

• Tinaglia, Angeliki G., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Angeliki G. Tinaglia

• Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Andrew D. Rule, MD, MS, FASN

• Barreto, Erin F., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Erin F. Barreto, PharmD, MS, FASN

Group or Team Name

• ACT Study.

Background

Acute kidney injury (AKI) survivors are at risk for not receiving needed follow-up medical care after discharge. This study assessed the feasibility and preliminary efficacy of a multidisciplinary AKI survivor care delivery model (AKI in Care Transitions - ACT).

Methods

This was a single-center randomized controlled trial of individuals with stage 3 AKI during a hospitalization discharged to home and not on dialysis. Patients were randomized 1:1 to the ACT intervention or usual care. The ACT intervention group received education from nurses and coordination of laboratory and clinical follow-up with a primary care provider and a pharmacist ideally within 14-days after hospital discharge. The primary objective was to determine feasibility of the ACT trial from the proportion of patients screened, who consented, randomized, and actually participated in the trial. Secondarily, efficacy outcomes were explored.

Results

Over 18 months, 118 individuals were eligible and 50 (42% of those approached) consented and were randomized. Participants were similar to nonparticipants. The ACT intervention group received education and care coordination as intended in 22 (88%) cases. More ACT intervention patients had complete clinical and laboratory follow-up in 30-days (ACT 60% vs Usual Care 24%; P = 0.01), and fewer experienced a >30% decline in estimated glomerular filtration rate at 90-days (ACT 14% vs Usual Care 38%; P = 0.088), although this difference was not statistically significant.

Conclusion

The results demonstrated the feasibility of the ACT trial and justify an adequately powered trial of the efficacy of ACT in non-dialysis dependent AKI survivors.

Funding

• Other NIH Support