The overarching goal of this competitive revision application is to extend the mission of the University of Alabama at Birmingham (UAB)-University of California, San Diego (UCSD) O?Brien Center for Acute Kidney Injury (AKI) Research by defining the impact of AKI on the excess burden of chronic kidney disease (CKD) in the Southeastern US. The clustering of major CKD risk factors such as black race, obesity and diabetes in our region is a key driver of the high prevalence of CKD in the Southeastern US. As such, identifying potential interventions to reduce the incidence and progression of CKD in these vulnerable populations is critical for reducing the substantial social and financial costs associated with CKD and related health disparities (stroke, heart disease, death) in our region. AKI affects as many as 20% of hospitalized patients and is a recognized risk factor for the development of CKD, cardiovascular disease and death. These outcomes may be modifiable by care provided in the post-AKI period, yet optimum care for care of AKI survivors is not well defined and is often fragmented after discharge. Disadvantaged patients are at especially high risk for inappropriate follow-up and low quality of care, suggesting that disparities in AKI outcomes contribute to the excess risk of incident and progressive CKD in high-risk populations in our region. However, progress in this area is hampered by a lack of data on the degree to which differences in AKI outcomes contribute to CKD disparities in the Southeastern US, and potential interventions that may target these disparities. Accordingly, the primary focus of this application is to define the impact of AKI during acute hospitalization on incident and progressive CKD; how these associations differ by race, obesity and diabetes status; and pilot a dedicated AKI follow-up clinic as a potential intervention to address disparities in these outcomes. Specifically, Aim 1 will leverage an established, ongoing regional CTSA collaboration?the Southeastern Shared Health Research Information Network (SE-SHRINE)?to examine all hospitalized AKI patients within four centers (UAB, MUSC, UAMS, U Kentucky) and link them to the US Renal Data Systems to define disparities in AKI outcomes ([i] severity and duration of AKI; [ii] recovery of dialysis-dependent AKI or development of ESRD after discharge; and [iii] associated health disparities such as death and cardiovascular disease) by race, obesity and diabetes.
Aim 2 will assess the feasibility and collect key efficacy measures of a dedicated AKI follow-up clinic for patients with AKI discharged to the community at three Southeastern CTSA hubs (UAB, Vanderbilt, U Kentucky). We will leverage the resources available in O?Brien Cores to integrate existing intellectual and technological resources of UAB and facilitate the success of this project. This project will help build a collaborative research network for AKI research that could serve as a platform for multi-center, transdisciplinary science and clinical trials focused on reducing the burden of CKD and related health disparities in the Southeastern US.
Acute kidney injury (AKI) is a major cause for morbidity and mortality in hospitalized patients and likely contributes to disparities in chronic kidney disease in the Southeastern US. This application will extend the mission of the UAB-UCSD O?Brien Center for AKI research by addressing major gaps in our understanding of how differences in AKI outcomes may contribute to disparities in chronic disease burden in our region.
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