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Kidney Week

Abstract: TH-OR08

IMPROVE AKI: A Cluster-Randomized Trial of Team-Based Coaching Interventions to Improve AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Brown, Jeremiah R., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Solomon, Richard J., University of Vermont College of Medicine, Burlington, Vermont, United States
  • Stabler, Meagan E., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Davis, Sharon E., Vanderbilt University, Nashville, Tennessee, United States
  • Cox, Kevin C., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Westerman, Dax, Vanderbilt University, Nashville, Tennessee, United States
  • Dorn, Chad A., Vanderbilt University, Nashville, Tennessee, United States
  • O'Malley, James, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Matheny, Michael Edwin, Vanderbilt University, Nashville, Tennessee, United States
Background

Over 2 million people in the U.S. undergo cardiac catheterization procedures each year with acute kidney injury (AKI) occurring in up to 14% of all patients. However, orders are often not standardized to ensure adequate oral and intravenous fluids, reduced NPO time, and limited contrast dye dose across or within hospitals to prevent AKI. Therefore, we hypothesized that providing team-based coaching in a Virtual Learning Collaborative (VLC) would reduce post-procedural AKI incidence compared to Technical Assistance (TA), both with and without Automated Surveillance Reporting (ASR).

Methods

We conducted a 2x2 factorial cluster-randomized trial that randomized 20 hospitals to receive TA, TA+ASR, VLC, or VLC+ASR for 18-months. All sites received an AKI Prevention Toolkit that included AKI preventive strategies. We fit multilevel logistic models for AKI with site-level random effects to account for the clustered design.

Results

Across 20 randomized Veterans Administration medical centers, there were 4,517 patients including 1,153 patients with pre-existing chronic kidney disease (CKD) during the 18-month intervention phase of the trial. There were 510 AKI events (214 among CKD patients). In all patients, the VLC+ASR intervention cluster had a substantial reduction in AKI when compared to TA alone (aOR=0.55; 0.36, 0.84) mirrored by a strong yet non-significant effect among CKD patients (aOR: 0.76; 0.46, 1.24).

Conclusion

This implementation trial estimates that the combination of VLC with ASR reduces AKI by a highly significant 45% at an institution and is suggestive of a reduction among CKD patients. Therefore, the combined VLC with ASR team-based coaching intervention is an effective, scalable framework to establish aggressive prevention protocols to prevent AKI.

Funding

  • NIDDK Support