NDLI: Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial

Content Provider	Springer Nature : BioMed Central
Author	Thanapongsatorn, Peerapat Chaikomon, Kamolthip Lumlertgul, Nuttha Yimsangyad, Khanitha Leewongworasingh, Akarathep Kulvichit, Win Sirivongrangson, Phatadon Peerapornratana, Sadudee Chaijamorn, Weerachai Avihingsanon, Yingyos Srisawat, Nattachai
Abstract	Background Currently, there is a lack of evidence to guide optimal care for acute kidney injury (AKI) survivors. Therefore, post-discharge care by a multidisciplinary care team (MDCT) may improve these outcomes. This study aimed to demonstrate the outcomes of implementing comprehensive care by a MDCT in severe AKI survivors. Methods This study was a randomized controlled trial conducted between August 2018 to January 2021. Patients who survived severe AKI stage 2–3 were enrolled and randomized to be followed up with either comprehensive or standard care for 12 months. The comprehensive post-AKI care involved an MDCT (nephrologists, nurses, nutritionists, and pharmacists). The primary outcome was the feasibility outcomes; comprising of the rates of loss to follow up, 3-d dietary record, drug reconciliation, and drug alert rates at 12 months. Secondary outcomes included major adverse kidney events, estimated glomerular filtration rate (eGFR), and the amount of albuminuria at 12 months. Results Ninety-eight AKI stage 3 survivors were enrolled and randomized into comprehensive care and standard care groups (49 patients in each group). Compared to the standard care group, the comprehensive care group had significantly better feasibility outcomes; 3-d dietary record, drug reconciliation, and drug alerts (p < 0.001). The mean eGFR at 12 months were comparable between the two groups (66.74 vs. 61.12 mL/min/1.73 m2, p = 0.54). The urine albumin: creatinine ratio (UACR) was significantly lower in the comprehensive care group (36.83 vs. 177.70 mg/g, p = 0.036), while the blood pressure control was also better in the comprehensive care group (87.9% vs. 57.5%, p = 0.006). There were no differences in the other renal outcomes between the two groups. Conclusions Comprehensive care by an MDCT is feasible and could be implemented for severe AKI survivors. MDCT involvement also yields better reduction of the UACR and better blood pressure control. Trial registration Clinicaltrial.gov: NCT04012008 (First registered July 9, 2019).
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/s13054-021-03747-7.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/s13054-021-03747-7
Journal	Critical Care
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2021-08-31
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Post-acute kidney injury Comprehensive care Severe AKI Critically ill patients AKI survivors
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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