(1406) Acute Kidney Injury in Care Transitions (ACT) Trial: A Post Hoc Analysis of ICU Survivors

Introduction: Up to 40-60% of ICU patients experience acute kidney injury (AKI). Innovative survivor care delivery models attentive to critical illness sequelae, kidney recovery, and patient and caregiver preferences are needed to improve outcomes. We report a post-hoc analysis of critically ill patients in a randomized trial that aimed to test the feasibility of a novel care transitions framework (ACT).

Methods: The study included adults with stage 3 AKI during hospitalization from 2022-2023 at Mayo Clinic in Rochester, MN, who discharged to home locally, not on dialysis. Consenting individuals were randomized 1:1 to ACT or Usual Care. The ACT group received kidney health education before discharge and coordination of post-discharge laboratory (serum creatinine, urine protein assessment) and clinician (primary care physician [PCP], pharmacist) follow-up in primary care within 14 days. The Usual Care group received no study-specific intervention. We describe 30-day follow-up and 90-day kidney function outcomes and readmissions for the subgroup of included participants requiring ICU admission during hospitalization.

Results: 15 of 25 participants (60%) in each of the ACT and Usual Care groups required ICU admission during hospitalization. ICU length of stay was 2.0 (1.8, 6.6) and 2.7 (1.4, 5.6) days in the ACT and Usual Care groups, respectively. Complete clinical and laboratory follow up at 30 days occurred in 53% and 27% of the ACT and Usual Care groups, respectively (p=0.3). A >30% decline in estimated glomerular filtration rate at 90 days occurred 15% and 36% of the ACT and Usual Care groups, respectively (p=0.4). Pharmacist visits occurred more often in the ACT group (ACT 73% vs Usual Care 0%; p< 0.01).

Conclusions: Results demonstrate feasibility of trial participation amongst critically ill AKI survivors included in a randomized trial. A larger trial is warranted to test the effectiveness of ACT to improve kidney health follow-up for patients who require ICU care during hospitalization.