None listed
Conditions
Brief summary
Acute kidney injury is an increasingly common complication of acute illness in hospitalised patients. In the future, it can lead to chronic kidney disease, end-stage kidney disease, and death. The aim of this study is to investigate whether specialised nephrology follow-up after acute kidney injury is feasible and whether it is effective and reducing the long-term complications of this disease. The specialised nephrology follow-up includes a bundle of care aimed at addressing risk factor for chronic kidney disease and cardiovascular disease.
Interventions
Patients randomised to the intervention arm will be reviewed one-on-one by a nephrologist (or a nephrology advanced trainee under the supervision of a nephrologist) in an outpatient clinic within 30 days (± 2 weeks) of discharge from the acute hospital. This will be in addition to standard care. Reviews will last for 20 to 30 minutes and will occur every 3 months until the end of the study, with the final review occurring 12 months after enrolment (+ or - two weeks). At each clinic visit, a post
Patients randomised to the intervention arm will be reviewed one-on-one by a nephrologist (or a nephrology advanced trainee under the supervision of a nephrologist) in an outpatient clinic within 30 days (± 2 weeks) of discharge from the acute hospital. This will be in addition to standard care. Reviews will last for 20 to 30 minutes and will occur every 3 months until the end of the study, with the final review occurring 12 months after enrolment (+ or - two weeks). At each clinic visit, a post-AKI care bundle will be implemented, based on international consensus guidelines for the prevention of CKD progression and cardiovascular risk. The care bundle includes: • Use of renin-angiotensin-aldosterone blockers according to the recommendations made by the Kidney Disease: Improving Global Outcomes (KDIGO) or National Heart Foundation of Australia guidelines (proteinuria, reduced left ventricular systolic function, coronary heart disease). The choice of agent, dose and frequency will be at the discretion of the clinician. • Targeted blood pressure control according to the recommendations made by the KDIGO or National Heart Foundation of Australia guidelines (<130/80mmHg in patients with proteinuria or cardiovascular disease; <140/90mmHg in other patients) • Assessment of cardiovascular risk using www.cvdcheck.org.au/calculator • Optimisation of cardiovascular risk using antiplatelet agents, cardioselective beta blockers and statins, according to the recommendations made by the KDIGO and National Heart Foundation of Australia guidelines. The choice of agent, dose and frequency will be at the discretion of the clinician. • Rationalisation of medications by ensuring that all non-essential nephrotoxic agents are discontinued and that the dose of all medications is appropriate for the patient’s level of renal function • Review of volume state by clinical examination • Targeted glycaemic control, as recommended by the KDIGO guidelines (HbA1c below 7.0%), through diet control, oral hypoglycaemic agents and/or insulin therapy • Implementation of healthy lifestyle interventions, including encouraging smoking cessation; limitation of daily sodium intake to less than 2g/day and daily alcohol intake to no more than 2 standard drinks for males and no more than 1 standard drink for females; regular moderate-intensity exercise (30 minutes on most days); and targeting a body mass index between 18.5 to 25kg/m2 Adherence to the bundle will be measured at the level of the clinician; that is, the number of interventions within the bundle that are addressed/performed at each visit. Low-risk individuals will be eligible for review every 6 months (with a blood and urine test at 3 months). To be considered low risk, individuals must meet all of the following criteria: • Baseline eGFR >60ml/min/1.73m2 • Return of creatinine to within 25% of baseline • All CKD prevention strategies are in place and all cardiovascular risk factors are optimised • No serious adverse events have occurred since the last visit
Sponsors
Austin Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
ALL of the following: 1. Adult patients admitted to ICU or CCU 2. Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3 AKI 3. Alive and independent of RRT for 72 hours at discharge with no plan for RRT following discharge from hospital 4. Written informed consent
Exclusion criteria
ANY of the following: 1. Age less than 18 years 2. Life expectancy <90 days 3. Baseline eGFR <30mL/min/1.73m2 (or no eGFR within 12 months) 4. Kidney transplant recipient 5. AKI due to suspected or proven glomerulonephritis, vasculitis, tubulointerstitial nephritis, thrombotic microangiopathy, pregnancy, myeloma, or hepatorenal syndrome 6. Previously enrolled in this study 7. Previously reviewed by a nephrologist within the preceding 12 months with the intention of ongoing follow-up
Outcome results
None listed