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Abstract: TH-PO051

Multidisciplinary Care Improves Follow-Up for AKI Survivors

Session Information

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 disease6 (46)11 (61)6 (40)-
Dialysis during hospitalization04 (22)2 (15)-
Dismissal eGFR (ml/min/1.73m2)40 (16, 58)29 (19, 54)31 (16, 58)-
Process, Clinical Outcomes
30-day serum creatinine11 (85)14 (78)14 (93)0.52
30-day urine protein2 (15)5 (28)13 (87)<0.001
Days to first urine protein35 (28,78)20 (7, 52)5.5 (2, 9)0.001
30-day primary care follow-up12 (92)11 (61)12 (80)0.12
30-day nephrology follow-up1 (8)3 (17)5 (33)0.22
30-day readmission3 (23)8 (44)2 (13)0.13

N(%); median(IQR)

Figure 1. Study Design

Funding

  • NIDDK Support