The Southeastern Acute Kidney Injury (SEAK) Alliance for the COPE-AKI Consortium

COPE-AKI 联盟东南部急性肾损伤 (SEAK) 联盟

• 批准号: 10451665
• 负责人: Javier A. Neyra
• 金额: $ 66.67万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-19 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10451665
• 关键词: Academic Medical Centers; Acute Renal Failure with Renal Papillary Necrosis; Address; Adult; Affect; Alabama; Albuminuria; Aldosterone Antagonists; Ambulatory Care; Angiotensins; Attention; Behavioral; Blood Pressure; Cardiovascular Diseases; Caring; Catchment Area; Cessation of life; Chronic Kidney Failure; Clinic Visits; Clinical; Clinical Trials Design; Cognitive; Collaborations; Complication; Country; Couples; Creatinine; Data; Dialysis procedure; Disease Progression; Dose; Electronic Health Record; Elements; Emergency department visit; Enrollment; Ensure; Ethics; Event; Exercise; Face; Fatigue; Glomerular Filtration Rate; Goals; Health; Heart failure; Home; Hospitalization; Hospitals; Human; Incidence; Individual; Infrastructure; Intervention; Investments; Kidney; Kidney Diseases; Life; Longitudinal Studies; Measures; Medical center; Medicine; Mental Depression; Minority Groups; Modification; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Outcome; Patient Care; Patient Education; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmaceutical Preparations; Physical activity; Physical therapy; Population; Population Heterogeneity; Principal Investigator; Process; Proteinuria; Public Health; Quality of Care; Quality of life; Randomized; Randomized Clinical Trials; Recovery; Recovery of Function; Recurrence; Renal function; Renin; Research; Risk; Risk Factors; SF-36; Self-Direction; Serum; Survivors; Symptoms; Telephone; Testing; Time; United States National Institutes of Health; Universities; Work; acute care; barrier to care; base; cardioprotection; caregiver education; clinical center; design; disadvantaged population; experience; follow-up; functional status; health related quality of life; high risk population; hospital readmission; improved; improved outcome; injury recovery; innovation; medication safety; modifiable risk; mortality; motivational enhancement therapy; multi-component intervention; nephrotoxicity; novel; novel strategies; palliative; patient engagement; patient population; posthospitalization care; primary endpoint; primary outcome; recruit; remote delivery; response; secondary analysis; secondary endpoint; secondary outcome; skills; socioeconomics; success; symposium; telehealth; transportation access; treatment as usual

Acute kidney injury (AKI) is an enormous public health problem that affects up to 20% of hospitalized patients, is strongly associated with morbidity and mortality, and carries a high financial toll. Nowhere is this more apparent than in the Southeastern US, which is disproportionately affected by kidney disease and its complications. AKI is an important risk factor for chronic kidney disease (CKD), cardiovascular disease, poor health-related quality of life (HRQoL), rehospitalizations, and death after hospital discharge. Improving the quality of care following hospitalization has been recognized by the National Institute of Diabetes and Digestive and Kidney Diseases and other stakeholders as a critical opportunity to reduce the risk for these long-term complications. Despite this emphasis, care of AKI survivors is often poor and fragmented, and patients face both systemic and individual-level barriers to optimal care. These include poor access to nephrology-specific care elements such as monitoring of kidney function for recovery or recurrent AKI, risk factor identification and modification for kidney disease progression, medication reconciliation and nephrotoxin avoidance, use of kidney and cardioprotective medications, and appropriate patient and caregiver education. In addition, many patients also experience poor quality of life and other barriers to care, including a heavy symptom burden and fatigue, limited mobility, reduced access to transportation or ability to miss work that can further limit engagement in care. This application will perform a randomized clinical trial designed to examine whether two interventions delivered remotely via telehealth can overcome these barriers to reduce clinical complications and improve health-related quality of life among patients discharged from the hospital with moderate to severe AKI. Two interventions will be tested over a 90-day period following hospital discharge. The first intervention is a ‘post-hospitalization AKI care bundle’ designed to optimize care that includes monitoring of kidney health, medication safety review and reconciliation, patient and caregiver education, and identification of modifiable risk factors for further loss of kidney function. The second intervention is cognitive-behavioral based physical therapy (CBPT), a novel home-based intervention that couples self-directed exercise with cognitive-behavioral strategies that can reduce patient’s perception of symptoms and improve engagement and functional status. We will test the ability of these interventions to improve clinical outcomes after AKI such as rehospitalizations/emergency room visits, recurrent AKI, death, and kidney function at 90 days. We will also evaluate health-related quality of life and symptom burden. Patients will be followed for up to 12 months after enrollment to examine the longer-term impact of these interventions. The study will be performed at Vanderbilt University Medical Center (PI Siew) and University of Alabama Birmingham (MPI Gutierrez), two academic medical centers in the Southeast with diverse patient populations and robust infrastructures to support the proposed work and objectives of the Caring for Outpatients after Acute Kidney Injury (COPE-AKI) Consortium.

急性肾损伤 (AKI) 是一个巨大的公共卫生问题，影响高达 20% 的住院患者， 与发病率和死亡率密切相关，并造成巨大的经济损失。 与美国东南部相比，该地区明显受到肾脏疾病及其相关疾病的影响 AKI是慢性肾病（CKD）、心血管疾病、不良并发症的重要危险因素。 改善与健康相关的生活质量 (HRQoL)、再住院和出院后的死亡。 住院后的护理质量已获得国家糖尿病和消化研究所的认可 和肾脏疾病和其他利益相关者作为降低这些长期风险的关键机会 尽管如此强调，AKI 幸存者的护理往往很差且分散，患者面临着并发症。 系统和个人层面的最佳护理障碍包括难以获得肾脏病学特定的服务。 护理要素，例如监测肾功能是否恢复或复发 AKI、危险因素识别和 改变肾脏疾病进展、药物协调和避免肾毒素、使用 此外，肾脏和心脏保护药物，以及适当的患者和护理人员教育。 患者还经历着生活质量差和其他护理障碍，包括严重的症状负担和 疲劳、行动不便、交通便利或错过工作可能会进一步限制 该应用程序将执行一项随机临床试验，旨在检查是否有两种情况。 通过远程医疗远程提供的干预措施可以克服​​这些障碍，减少临床并发症 改善中度至重度出院患者的健康相关生活质量 AKI。将在出院后 90 天内测试两项干预措施。 是一个“AKI 住院后护理包”，旨在优化护理，包括监测肾脏健康状况， 药物安全审查和协调、患者和护理人员教育以及可修改的识别 肾功能进一步丧失的危险因素第二个干预措施是基于认知行为的身体干预。 疗法（CBPT），一种新颖的家庭干预措施，将自我指导运动与认知行为结合起来 可以减少患者对症状的感知并提高参与度和功能状态的策略。 我们将测试这些干预措施改善 AKI 后临床结果的能力，例如 我们还将评估 90 天时的再住院/急诊室就诊、复发性 AKI、死亡和肾功能。 评估与健康相关的生活质量和症状负担后将对患者进行长达 12 个月的随访。 该研究将在范德比尔特大学进行，以检验这些干预措施的长期影响。 大学医学中心 (PI Siew) 和阿拉巴马大学伯明翰分校 (MPI Gutierrez)，两个学术中心 东南部的医疗中心拥有多样化的患者群体和强大的基础设施来支持 急性肾损伤后门诊患者护理 (COPE-AKI) 联盟的拟议工作和目标。