Multidiscipline Care for Acute Kidney Disease (AKD) (AKD)
Acute Kidney Injury
About this trial
This is an interventional prevention trial for Acute Kidney Injury focused on measuring Chronic kidney disease, Acute kidney disease
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 20 years old on the day of index discharge
- 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.
- Patients who has KDIGO-AKI stage 2, 3 or who could wean from dialysis requiring AKI-D in the index hospitalization.
Exclusion Criteria:
- 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.
- Patients receive further re-dialysis within 90 days after index hospital discharge, who are withdrawal for AKI-D. (sensors)
- Previous gastrointestinal operations.
- Patients with major hemorrhage, as defined with acute hemorrhage and requirement of blood transfusion during index admission.
- Patients with a chronic lung disease requiring non-invasive or invasive positive pressure ventilation.
- Solid organ or hematological transplantation donors.
- Evidence of obstructive acute kidney injury.
- Systolic blood pressure < 110mmHg.
- Pregnant women
Sites / Locations
- Kaohsiung Medical University Hospital
- Keelung CGMHRecruiting
- China Medical University HospitalRecruiting
- Taichung Veterans General HospitalRecruiting
- National Taiwan University HospitalRecruiting
- Taipei Veterans General HospitalRecruiting
- Linkou Chang Gung Memorial HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
never received RAAS blockers or multidiscipline consultation before AKI.
had received RAAS blockers and multidiscipline consultation before AKI.
The enrollees assigned to the control group should not receive RAAS blockers or AKD consultation at least in 180 days after index discharge. In addition, these multidiscipline consultation and administration of RAAS blockers are continuing, and results regarding them remain masked. All patients provided written informed consent.
All enrolled patients are randomly referred to receive comprehensive multidiscipline consultation targeting a glycated hemoglobin level of less than 7.0%, systolic blood-pressure, target, <130 mm Hg, low density lipid (LDL) less than 100mg/dL and control of hyperuricemia less than 7.2mg/deal in male as well as 6.1mg/dl in females. We suggest to adherence to low protein diet achieve the goal of hemoglobin more than 11g/L at 180 day after index discharge. Enrollees who are not received renin-angiotensin-aldosterone blockers (RAAS) are randomly assigned to slow kidney function progression by adding RAAS blockers by receiving at least defined daily dose equal to Losartan 50mg or Captopril 25mg bid. The acute kidney disease (AKD) consultation should be transferred at least one time within 90 days after index hospital discharge after withdrawing from dialysis requiring AKI (AKI-D).