Kidney Week

Abstract: TH-PO1166

Advancing Community Care and Access to Follow-Up after AKI Hospitalization: The AFTER AKI Randomized Controlled Trial

Session Information

• Late-Breaking Science Posters
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Pannu, Neesh I., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Neesh I. Pannu, MD

• Mcbrien, Kerry, University of Calgary, Calgary, Alberta, Canada

Kerry Mcbrien, MD, MPH

• Bignell, Coralea, University of Calgary, Calgary, Alberta, Canada

Coralea Bignell

• Benterud, Eleanor C., University of Calgary, Calgary, Alberta, Canada

Eleanor C. Benterud, RN

• Palechuk, Taylor, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Taylor Palechuk, MSc

• Harrison, Tyrone, University of Calgary, Calgary, Alberta, Canada

Tyrone Harrison, MD, PhD

• Manns, Braden J., University of Calgary, Calgary, Alberta, Canada

Braden J. Manns, MD

• James, Matthew T., University of Calgary, Calgary, Alberta, Canada

Matthew T. James, MD, PhD

Background

Acute kidney injury (AKI) is associated with development and progression of chronic kidney disease (CKD). Gaps in guideline recommended care for CKD are common after AKI.

Methods

In this randomized controlled trial conducted in Alberta, Canada, hospitalized adults with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI were randomized to a risk-guided, transition of care intervention versus usual discharge practices at hospital discharge. For people in the intervention group, we used a validated risk index to predict risk of severe CKD after AKI to risk stratify patients. People at low risk (<1%) received patient education alone. People at medium risk received additional clinical guidance, provided to their primary care physician. People at high risk (>10%) were referred to Nephrology. The primary outcome was the proportion of patients with CKD who were receiving guideline-concordant care at 90 days after discharge based on use of ACE inhibitors or ARBs, statins, and nephrology specialist follow-up. Processes of care and safety were also evaulated.

Results

We recruited 155 patients into the trial; mean (SD) age 60 (15) years, 91 (60%) were male. 90 days after discharge, 99 (64%) participants had CKD defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² or albumin to creatinine ratio (ACR) >30 mg/g. The proportion of participants with CKD after hospitalization with AKI who received guideline-concordant care was 59% in the intervention group versus 24% in the usual-care group (absolute risk difference [RD] 35 %, 95% CI, 17 to 53%; P < 0.001; risk ratio 2.47, 95% CI, 1.43 to 4.25). ACE inhibitor or ARB use was higher with the intervention (67 versus 46%, RD 21%, 95% CI, 2-40] %), as was statin use (78 versus 58%, RD 20%, 95% CI, 2 to 38 %). Among 18 (12%) participants with eGFR <30 mL/min/1.73m² at 90 days, the proportion who received nephrology follow-up was also greater with the intervention (73 versus 29%, RD 44, 95% CI, 2 to 87%). The risk of adverse events was similar in the groups, except for hyperkalemia, which was more frequent in the intervention group (15% versus 5%).

Conclusion

A risk-guided intervention for patients with AKI increased CKD-guideline concordant care early after hospital discharge.

Funding

• Government Support - Non-U.S.