KEY POINTS: A risk-guided intervention improved adherence to processes of care for AKI survivors. Further supports are necessary to improve uptake of processes of care for AKI survivors in primary care. BACKGROUND: AKI is associated with development and progression of CKD. Gaps in recommended care for CKD are common after AKI. METHODS: In this randomized controlled trial conducted in Alberta, Canada, we allocated adults hospitalized with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI to a risk-guided, transition of care intervention versus usual practices at the time of hospital discharge. For people in the intervention group, we used a validated risk index to predict risk of severe CKD after AKI. 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 who received treatment with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB), statin, and nephrology specialist follow-up within 90 days of discharge. RESULTS: One hundred fifty-five patients were recruited
the mean (SD) age was 60 (15) years, 91 (60%) were male, and 96 (62%) had eGFR <
60 ml/min per 1.73 m CONCLUSIONS: A risk-guided intervention for patients hospitalized with AKI increased recommended processes of care for CKD for high-risk patients after hospital discharge. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER:: Improving Post Discharge Care after Acute Kidney Injury (AFTER AKI), NCT02915575.