male doctor speaking with a female patient

UPTAKE-1

Using Personalized risk and digital tools to guide Transitions following Acute Kidney Events

UPTAKE-1 is a pragmatic trial that focuses on identifying patients who have had Acute Kidney Injury (AKI) at the time of their hospital discharge, and delivering a decision support, transition of care intervention within Connect Care for patients and their care providers. The recommendations provided for patients receiving the intervention are based on international guidelines and quality improvement recommendations to improve the quality of discharge care based on each patient’s risk of adverse long-term kidney and cardiovascular outcomes. 

Pilot phase: will include units at University of Alberta Hospital (Edmonton) and Foothills Medical Centre (Calgary) 

Full Randomized Trial: will include all acute care sites in Alberta

Eligible patients who have had AKI identified in hospital, are at increased risk of advanced chronic kidney disease (CKD) and are being discharged home will be automatically randomized within Connect Care to the intervention (see below) or to usual care.

Inclusion Criteria (all of):

  • ≥ 18 years old
  • AKI stages 1 to 3 based on serum creatinine changes in hospital

Exclusion Criteria (any of):

  • Pre-hospitalization advanced CKD: eGFR<30 mL/min/1.73m2
  • Pre-hospitalization dialysis
  • Very low risk (<1% risk) of advanced CKD 
  • Non-Alberta resident 
  • Palliative goals of care 
  • Enrolled in the UPTAKE VC Trial
  • Admitted to a nephrology service
  • Dialysis on at least 2 days in the last week prior to discharge
  • Receiving apheresis
  • Kidney transplant recipient
  • Diagnosis of  Glomerulonephritis
  • Cirrhosis AND complication of cirrhosis in medical history or active problem list (ascites, varices, hepatic encephalopathy, hepatorenal syndrome)

Intervention:

Risk-guided transition of care interventions based on patient risk of advanced CKD following AKI (low 1-9%, medium 10-19%, high ≥20%) and additional clinical characteristics, delivered through decision support tools within Connect Care for patients and health care providers at the time of discharge, with guidance provided in the following areas:

  • Education and self-management guidance about AKI for patients provided on the After Visit Summary
  • Medication guidance based on evidence-based indications for reducing risk of cardiac and kidney outcomes
  • Recommendations for subsequent laboratory testing of kidney function and electrolytes according to clinical characteristics and risks
  • Recommendations for timing and nature of Primary Care follow-up
  • Information about the patient’s AKI and subsequent management provided to Primary Care providers through discharge summary 
  • Recommendations for outpatient Pharmacy follow-up for medication reconciliation and review according to patient risk and medication management gaps.
  • Recommendations for outpatient Nephrology referral (for patients at high risk of advanced CKD)

These will be suggested in a best practice advisory at the time of discharge medication reconciliation to the discharging clinician, along with a patient-specific order set that includes all of the recommendations tailored to that patient. Only the intervention group will receive the tailored order set, and this will be different for each patient.

Outcomes:

Primary: Major adverse kidney or cardiovascular events 1- and 2-years following discharge (death, eGFR <15 mL/min/1.73m2 or dialysis > 4 weeks, hospitalization for heart failure, myocardial infarction, or stroke)

Secondary:

  • Death
  • Kidney failure
  • Hospitalizations for heart failure, myocardial infarction, stroke
  • All cause hospitalizations within 30 and 90 days 
  • Patient experience 
  • Processes of care

Sample size: 6,046 total (3,023 per arm)

Consent: Ethics approval has been obtained from ethics boards of both University of Alberta and University of Calgary, including a waiver of patient consent.