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. 2025 Mar 1;36(3):441-450.
doi: 10.1681/ASN.0000000537. Epub 2024 Oct 24.

Advancing Community Care and Access to Follow-Up after Acute Kidney Injury Hospitalization: A Randomized Clinical Trial

Neesh Pannu  1 , Kerry A McBrien  2   3   4 , Zhi Tan  2 , Nasreen Ahmad  1 , Coralea Bignell  2 , Eleanor Benterud  2 , Taylor Palechuk  1 , Tyrone G Harrison  2   3   4   5 , Braden J Manns  2   3   4   5 , Nairne Scott-Douglas  2   5 , Matthew T James  2   3   4   5
Affiliations

Advancing Community Care and Access to Follow-Up after Acute Kidney Injury Hospitalization: A Randomized Clinical Trial

Neesh Pannu et al. J Am Soc Nephrol. .

Abstract

Key Points:

  1. A risk-guided intervention improved adherence to processes of care for AKI survivors.

  2. Further supports are necessary to improve uptake of processes of care for AKI survivors in primary care.

Background: AKI is associated with development and progression of CKD. Gaps in recommended care for CKD are common after AKI.

Methods: In this randomized controlled trial conducted in Alberta, Canada, we allocated adults hospitalized with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI to a risk-guided, transition of care intervention versus usual practices at the time of hospital discharge. For people in the intervention group, we used a validated risk index to predict risk of severe CKD after AKI. People at low risk (<1%) received patient education alone. People at medium risk received additional clinical guidance, provided to their primary care physician. People at high risk (>10%) were referred to nephrology. The primary outcome was the proportion of patients who received treatment with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB), statin, and nephrology specialist follow-up within 90 days of discharge.

Results: One hundred fifty-five patients were recruited; the mean (SD) age was 60 (15) years, 91 (60%) were male, and 96 (62%) had eGFR <60 ml/min per 1.73 m2 or urine albumin-creatinine ratio >30 mg/g at discharge. The proportion of participants who received ACE-I/ARB, statin treatment, and nephrologist follow-up was 28% in the intervention group versus 3% in the usual care group (absolute risk difference [RD], 25%; 95% confidence interval [CI], 15% to 36%). The use of ACE-I or ARB in participants with urine albumin-creatinine ratio >300 mg/g or diabetes was greater in the high-risk group with the intervention versus usual care (RD, 37%; 95% CI, 6% to 67%), as was statin use among those with CKD (RD, 30%; 95% CI, 5% to 56%) and nephrologist follow-up for those with sustained eGFR <30 ml/min per 1.73 m2 at discharge (RD, 78%; 95% CI, 56% to 100%). Hyperkalemia was more frequent in the intervention group (RD, 10%; 95% CI, 9% to 19%).

Conclusions: A risk-guided intervention for patients hospitalized with AKI increased recommended processes of care for CKD for high-risk patients after hospital discharge.

Clinical Trial registry name and registration number:: Improving Post Discharge Care after Acute Kidney Injury (AFTER AKI), NCT02915575.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/E895.

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