Acute Kidney Injury & the UPTAKE Research Initiative

Each year, 5-9% of all hospitalized patients develop acute kidney injury (AKI), affecting over 30,000 Albertans and more than 200,000 Canadians. Acute Kidney Injury is characterized by a sudden loss of kidney function and is associated with poor health outcomes. Unfortunately, these patients are at significantly high risk for further complications: one in five patients who survive a hospitalization are readmitted to the hospital within 30 days-a rate 40% higher than for other medical patients.

For those discharged following an AKI episode, the risks of long-term health issues are substantial. Patients face an 8-fold increased risk of developing chronic kidney disease (CKD) and are more than 10 times more likely to progress to kidney failure, requiring dialysis or transplant. Additionally, they have a 50-60% greater risk of experiencing severe cardiovascular events, such as heart failure, heart attack, or stroke. Alarmingly, within the next year, these individuals also face a risk of death that exceeds that of patients who have suffered a heart attack.

Despite these heightened risks, gaps in post-discharge care for patients with AKI are common. Sixty percent of patients receive no follow-up assessment within the first 30 days after discharge, and fewer than 5% see a nephrologist in the year following hospitalization. Even among those who develop CKD after AKI, fewer than 30% receive renin-angiotensin system inhibitors or statins-treatments known to help prevent kidney and cardiovascular complications.

Novel Solutions to Address These Key Challenges After AKI

The research team from the Interdisciplinary Chronic Disease Collaboration (ICDC) in the Department of Medicine, UCalgary, includes people with lived expe-rience, clinicians, health system decision makers, and researchers. The team uses an integrated knowledge translation approach to co-design, implement, and test novel solutions to address these key challenges in care after AKI.

Researchers on the team bring expertise in computerized clinical decision support, implementation science, and clinical trials. The work is being done in close partnership with AHS, including clinical informatics specialists with Connect Care, the Home to Hospital to Home Transition (H2H2H) Initiative, and Primary Health Care Integration Network. Drs. Maoliosa Donald, Tyrone Harrison, and Matthew James from the UCalgary and Neesh Pannu from UAlberta lead the research program. Additional members of the DOM involved with the project include Drs. Sandra Dumanski, Paul Davis, Meghan Elliott, Michelle Grinman, Rachel Jeong, Jennifer MacRae, and Pietro Ravani.

"As the people of the healthcare system strive to perfect the Quality of Care, I strive to achieve the best Quality of life. Together, we make an incredible team."

- D'Arcy Duquette, Patient Partner UPTAKE Project

Patient Partner Impact 

D’Arcy Duquette, a Patient Partner on the UPTAKE project describes his experience 

“I had surgery to remove a mass. Things did not go well. I was septic and placed in a medically induced coma for five weeks. This resulted in me spending 71 days in hospital and 16 months in physio recovering, which included three months of dialysis. I still have several issues, but I’m here, and I have learned to live with them. I enjoy sharing my lived experiences to make a positive impact on patients and families. I really enjoy these opportunities because they involve working together toward a common goal. As the people of the healthcare system strive to perfect the Quality of Care, I strive to achieve the best Quality of life. Together, we make an incredible team.  In this work, you are working with people within and outside the field of medicine who have knowledge and lived experiences beyond your own to achieve this complex understanding.”

Project Spotlight: UPTAKE

UPTAKE (Using Personalized risk and digital tools to guide Transitions following Acute Kidney Events) is a research initiative designed to implement and test innovations in care to improve the long-term outcomes for people in Alberta who have been hospitalized with Acute Kidney Injury (AKI). The UPTAKE project is focused around two inter-related randomized controlled trials, that build upon more than a decade of research on AKI at UCalgary. The trials include all patients 18 years of age or older who have been hospitalized with AKI stage 1-3.

UPTAKE-1

AKI can lead to chronic kidney disease (CKD) and related cardiovascular complications. For some individuals, the risks of these complications may be high, while for others, the risks are low. Previous research at UCalgary demonstrated that the risk of CKD following AKI could be predicted based on six routinely collected variables, and that outpatient follow-up strategies based on the risk model were superior to the usual care decisions.

In the UPTAKE project, clinicians and researchers are evaluating ways to improve the care, experiences, and long-term outcomes of people with AKI at the time of hospital discharge. This is achieved through the implementation of care interventions designed to improve continuity of care between hospital and home settings and are tailored to each individual person’s specific medical conditions and CKD risk profile.

The intervention is delivered through decision support tools and care pathways that are integrated with the Connect Care clinical information system across the province of Alberta. Its effectiveness is being tested in a pragmatic randomized trial, measuring the impact on important long-term kidney and cardiovascular health outcomes and patient experiences with their care. The project is funded by a Canadian Institutes of Health Research (CIHR) Transition in Care Team Grant.

UPTAKE - Virtual Care

Patients with AKI can also experience lengthy hospital stay and one in five are readmitted to hospital within 30 days following discharge, often for preventable reasons such as heart failure, recurrent AKI, or infection. The UPTAKE-VC project is using digital algorithms implemented in Connect Care to identify patients with AKI and a high risk of readmission or death and testing whether care incorporating digital remote monitoring in the Virtual Home Hospital programs in the Calgary and Edmonton Zones improves patient experiences and outcomes during this particularly vulnerable period of the hospital-to-home transition. Patients are provided with a take home kit with the ability to monitor blood pressure, weight and check in with a physician.

This randomized trial will compare the effect of the intervention to usual care on a primary outcome of days alive at home in the first 45 days following AKI, in addition to processes of care, and patient experi-ences with their transition from hospital to home. The project is funded by an Alberta Innovates Partnership for Research and Innovation in the Health System (PRIHS) Digital Health Grant.