Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial

Abstract

Background Currently, there is a lack of evidence to guide optimal care for acute kidney injury (AKI) survivors. Therefore, post-discharge care by a multidisciplinary care team (MDCT) may improve these outcomes. This study aimed to demonstrate the outcomes of implementing comprehensive care by a MDCT in severe AKI survivors. Methods This study was a randomized controlled trial conducted between August 2018 to January 2021. Patients who survived severe AKI stage 2–3 were enrolled and randomized to be followed up with either comprehensive or standard care for 12 months. The comprehensive post-AKI care involved an MDCT (nephrologists, nurses, nutritionists, and pharmacists). The primary outcome was the feasibility outcomes; comprising of the rates of loss to follow up, 3-d dietary record, drug reconciliation, and drug alert rates at 12 months. Secondary outcomes included major adverse kidney events, estimated glomerular filtration rate (eGFR), and the amount of albuminuria at 12 months. Results Ninety-eight AKI stage 3 survivors were enrolled and randomized into comprehensive care and standard care groups (49 patients in each group). Compared to the standard care group, the comprehensive care group had significantly better feasibility outcomes; 3-d dietary record, drug reconciliation, and drug alerts (p < 0.001). The mean eGFR at 12 months were comparable between the two groups (66.74 vs. 61.12 mL/min/1.73 m2, p = 0.54). The urine albumin: creatinine ratio (UACR) was significantly lower in the comprehensive care group (36.83 vs. 177.70 mg/g, p = 0.036), while the blood pressure control was also better in the comprehensive care group (87.9% vs. 57.5%, p = 0.006). There were no differences in the other renal outcomes between the two groups. Conclusions Comprehensive care by an MDCT is feasible and could be implemented for severe AKI survivors. MDCT involvement also yields better reduction of the UACR and better blood pressure control. Trial registration Clinicaltrial.gov: NCT04012008 (First registered July 9, 2019).

Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events

“…However, after patients at risk of MAKE have been identified, there is still no robust data about the benefits of a specific nephrology follow-up compared to standard care. The first randomized controlled trial investigating this was published in 2021 (19). Patients who survived severe AKI stage 2 or 3 were enrolled and randomized to receive either comprehensive or standard care for 12 months.…”

Pharmacy Practice Standards for Outpatient Nephrology Settings

“… 35 , 36 Briefly, these data demonstrate improved surrogate outcomes and in some cases, major clinical and cost outcomes. Examples include identifying and resolving medication therapy problems, deprescribing unnecessary or harmful medications, 37 improving blood pressure and albuminuria postacute kidney injury, 38 reducing risk categorization for patients with kidney transplant, 39 reducing hospital lengths of stay 35 and hospital readmissions among patients on dialysis, 36 and reducing medication errors, adverse events, and hospitalizations among transplant recipients 40 with associated cost savings. 41 Recent publications in primary care also demonstrated reduced physician burnout when pharmacists joined the care team as well as high levels of patient satisfaction.…”

Long-term outcomes in patients who received veno-venous extracorporeal membrane oxygenation and renal replacement therapy: a retrospective cohort study

“…Apart from a structured individualised follow-up care plan, there is a need for more research and intervention studies in post-AKI care. In particular, the role of biomarkers to predict patients at high-risk of developing worse kidney outcomes, the role of protective drugs like renin–angiotensin aldosterone inhibitors or statins in prevention of CKD after AKI, and the effectiveness of post-AKI clinic should be explored [ 41 – 43 ].…”