Advancing Community Care and Access to Follow-Up after AKI Hospitalization: The AFTER AKI Randomized Controlled Trial
Bibliographic record
Abstract
Background: Acute kidney injury (AKI) is associated with development and progression of chronic kidney disease (CKD). Gaps in guideline recommended care for CKD are common after AKI. Methods: In this randomized controlled trial conducted in Alberta, Canada, hospitalized adults with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI were randomized to a risk-guided, transition of care intervention versus usual discharge practices at hospital discharge. For people in the intervention group, we used a validated risk index to predict risk of severe CKD after AKI to risk stratify patients. People at low risk (<1%) received patient education alone. People at medium risk received additional clinical guidance, provided to their primary care physician. People at high risk (>10%) were referred to Nephrology. The primary outcome was the proportion of patients with CKD who were receiving guideline-concordant care at 90 days after discharge based on use of ACE inhibitors or ARBs, statins, and nephrology specialist follow-up. Processes of care and safety were also evaulated. Results: We recruited 155 patients into the trial; mean (SD) age 60 (15) years, 91 (60%) were male. 90 days after discharge, 99 (64%) participants had CKD defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 or albumin to creatinine ratio (ACR) >30 mg/g. The proportion of participants with CKD after hospitalization with AKI who received guideline-concordant care was 59% in the intervention group versus 24% in the usual-care group (absolute risk difference [RD] 35 %, 95% CI, 17 to 53%; P < 0.001; risk ratio 2.47, 95% CI, 1.43 to 4.25). ACE inhibitor or ARB use was higher with the intervention (67 versus 46%, RD 21%, 95% CI, 2-40] %), as was statin use (78 versus 58%, RD 20%, 95% CI, 2 to 38 %). Among 18 (12%) participants with eGFR <30 mL/min/1.73m2 at 90 days, the proportion who received nephrology follow-up was also greater with the intervention (73 versus 29%, RD 44, 95% CI, 2 to 87%). The risk of adverse events was similar in the groups, except for hyperkalemia, which was more frequent in the intervention group (15% versus 5%). Conclusion: A risk-guided intervention for patients with AKI increased CKD-guideline concordant care early after hospital discharge. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".