Multidiscipline Care for Acute Kidney Disease (AKD)

• Status: Recruiting
• Trial end date: 2024-02-15
• Target enrollment: 0
• Participant gender: All

Summary

The incidence rate of acute kidney injury (AKI) in hospitalized patients is increasing, and the mortality associated with dialysis-requiring AKI remains as high as 60-70%. In these patients, AKI results are increased in-hospital and post-hospitalization medical resource utilization. To improve AKI-associated morbidity and mortality, Taiwan Consortium of Acute Kidney Injury and Renal Diseases (CAKS, TCTC) as the leading clinical trial group of kidney diseases in Asia-Pacific will establish an anonymous nationwide AKI database to explore the epidemiology, risk factors and prognosis of AKI in Taiwan. The demographic and clinical information of AKI stage 2, 3 or weaning from dialysis requiring AKI patients (AKI-D), will be prospectively collected for further analysis. In this double two-by-two factorial design, upon the identification of AKI stage 2, 3 or weaning from AKI-D at index out patients clinics, enrollees who are randomly assigned to slow kidney function progression first by randomization to add Angiotensin-Converting Enzyme Inhibitors (ACE-I)/Angiotensin II Receptor Blocker (ARB), or by randomization to multidisciplinary care. Patients will be followed up at least 6 months to evaluate kidney function and the predictability of developing chronic kidney disease, end stage renal disease, major cardiovascular events and mortality.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Taiwan University Hospital
• Collaborator: Chang Gung Memorial Hospital

Criteria

Inclusion Criteria:

1. Age ≥ 20 years old on the day of index discharge

2. AKI develops during admission, as defined with KDIGO-AKI Guideline, namely, elevation of serum creatinine above 0.3mg/dL within two days, above 1.5 times baseline and ever receives dialysis during this index hospitalization.

3. Patients who has KDIGO-AKI stage 2, 3 or who could wean from dialysis requiring AKI-D in the index hospitalization.

Exclusion Criteria:

1. Baseline estimated glomerular filtration rates (eGFR) less than 5ml/min/1.73m2 or greater than 90ml/min/1.73m2 according to MDRD equation after index discharge.

2. Patients receive further re-dialysis within 90 days after index hospital discharge, who are withdrawal for AKI-D. (sensors)

3. Previous gastrointestinal operations.

4. Patients with major hemorrhage, as defined with acute hemorrhage and requirement of blood transfusion during index admission.

5. Patients with a chronic lung disease requiring non-invasive or invasive positive pressure ventilation.

6. Solid organ or hematological transplantation donors.

7. Evidence of obstructive acute kidney injury.

8. Systolic blood pressure < 110mmHg.

9. Pregnant women