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The acute kidney outreach to prevent deterioration and death – a large pilot study for a cluster randomised trial

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Thomas, Mark E., Abdelaziz, Tarek S., Perkins, Gavin D., Sitch, Alice J., Baharani, Jyoti and Temple, R. Mark (2021) The acute kidney outreach to prevent deterioration and death – a large pilot study for a cluster randomised trial. Nephrology Dialysis Transplantation, 36 (4). pp. 657-665. gfz246. doi:10.1093/ndt/gfz246 ISSN 0931-0509.

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Official URL: https://doi.org/10.1093/ndt/gfz246

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Abstract

Background and objectives:
The Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) trial was a large pilot study for a cluster randomised trial of AKI Outreach.
Design, Setting, Participants, and Measurements:
An observational Control (Before) phase was conducted in two teaching hospitals (9 miles apart) and their respective catchment areas. In the Intervention (After) phase, a working hours AKI outreach service operated for the intervention hospital/area for 20 weeks, with the other site acting as a control. All AKI alerts in both hospital and community patients were screened for inclusion. Major exclusion criteria were patients who were end of life, or unlikely to benefit from Outreach, or lacking mental capacity, or already referred to the Renal team. The intervention arm included a model of escalation of renal care to AKI patients, depending on AKI stage. The 30-day primary outcome was a combination of death, or deterioration, as shown by any need for dialysis or progression in AKI stage. 1762 adult patients were recruited; 744 at the Intervention site during the After phase.
Results:
A median of 3.0 non-medication recommendations and 0.5 medication related recommendations per patient were made by the Outreach team, a median of 15.7 hours after the AKI alert. Relatively low rates of the primary outcomes of death within 30 days (11-15%), or requirement for dialysis (0.4 – 3.7%) were seen across all four groups. In an exploratory analysis, at the Intervention hospital during the After phase the was an odds ratio for the combined primary outcome of 0.73 (95% CI 0.42, 1.26, p = 0.26).
Conclusions:
An AKI outreach service can provide standardised specialist care to those with AKI across a healthcare economy. Trials assessing AKI outreach may benefit from focusing on those patients with "mid-range" prognosis, where nephrological intervention could have the most impact.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Acute renal failure -- Treatment -- Research, Kidneys -- Wounds and injuries
Journal or Publication Title: Nephrology Dialysis Transplantation
Publisher: Oxford University Press
ISSN: 0931-0509
Official Date: April 2021
Dates:
DateEvent
April 2021Published
20 December 2019Available
20 December 2019Accepted
Volume: 36
Number: 4
Page Range: pp. 657-665
Article Number: gfz246
DOI: 10.1093/ndt/gfz246
Status: Peer Reviewed
Publication Status: Published
Reuse Statement (publisher, data, author rights): This is a pre-copyedited, author-produced version of an article accepted for publication in Nephrology Dialysis Transplantation following peer review. The version of record Mark E Thomas, Tarek S Abdelaziz, Gavin D Perkins, Alice J Sitch, Jyoti Baharani, R Mark Temple, The Acute Kidney Outreach to Prevent Deterioration and Death trial: a large pilot study for a cluster-randomized trial, Nephrology Dialysis Transplantation, , gfz246, https://doi.org/10.1093/ndt/gfz246 is available online at: https://doi.org/10.1093/ndt/gfz246
Access rights to Published version: Restricted or Subscription Access
Date of first compliant deposit: 17 January 2020
Date of first compliant Open Access: 20 December 2020
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
PB-PG-1111-26038Research for Patient Benefit Programmehttp://dx.doi.org/10.13039/501100009128

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