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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
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Official URL: https://doi.org/10.1093/ndt/gfz246
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 | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| 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: |
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| Volume: | 36 | ||||||||
| Number: | 4 | ||||||||
| Page Range: | pp. 657-665 | ||||||||
| Article Number: | gfz246 | ||||||||
| DOI: | 10.1093/ndt/gfz246 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Publisher Statement: | 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 | ||||||||
| RIOXX Funder/Project Grant: |
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