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

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. In addition to the clustering of known risk factors (obesity, diabetes) for AKI In this region, AKI has also emerged as a risk factor for chronic kidney disease (CKD), cardiovascular disease, poor health-related quality of life (HRQoL), rehospitalizations, and death. 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, optimum care for care of AKI survivors is often poor and fragmented, particularly among the disadvantaged who face both systemic and individual-level barriers to post-AKI care that can contribute to CKD. These barriers include poor access to nephrology-specific care elements such as monitoring of kidney function for recovery or recurrent AKI, risk factor modification for kidney disease progression, medication reconciliation and nephrotoxin avoidance, use of kidney and cardioprotective medications, and appropriate in-person nephrology referral. In addition, many patients also experience a heavy symptom burden, limited mobility and motivation, fatigue, and reduced access to transportation or ability to miss work that can reduce engagement in the care. The overarching goal of this proposal is to demonstrate that a nephrologist-guided, multi-faceted intervention with the capability of remote application can bridge these disparities to provide clinical and patient-centered care effectively and efficiently. Specifically, we will apply a specific ‘post-hospitalization AKI care bundle’ following hospital discharge to improve adherence to clinical guidelines and provide other critical elements of care. Simultaneously, we will offer patients 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 process and clinical outcomes after AKI as well as HRQoL and symptom burden. We will also leverage the tele-health platform to improve accessibility and engagement based on feedback from patient consultant feedback. The study will be performed at Vanderbilt University Medical Center and University of Alabama Birmingham, two major academic medical centers in the Southeast that serve a large catchment of underserved patients and have a robust infrastructure to support the proposed work and the objectives of the Caring for Outpatients after Acute Kidney Injury (COPE-AKI) Consortium.