Understanding the Role of Patient Behavior Change in Improving AKI Outcomes

Acute kidney injury (AKI) is an increasingly common complication of acute hospitalizations.
Hospital-related AKI, commonly caused by hemodynamic changes or contrast exposure, carries a
threat of adverse outcomes that persists following hospital discharge, with an independent
and graded association with long-term mortality. It is estimated that, approximately 13% of
individuals with acute coronary syndrome (ACS) will develop some degree of AKI during their
hospitalization. Survivors of AKI consume significantly greater health resources than the
general population, and suffer exceedingly poor renal outcomes, including persistent loss of
kidney function, progression to end stage renal disease (ESRD), and increased risk of
recurrent AKI. It is estimated that 25% of individuals with an AKI-related hospitalization
will be readmitted with recurrent AKI within 12 months of discharge, highlighting a critical
need to address ongoing AKI risk once the acute hospitalization is complete. Patient-centered
educational interventions that intensify awareness of potentially hazardous situations may
reduce AKI recurrence. For example, commonly prescribed therapies such as diuretics or ACE
inhibitors may threaten the renal safety of individuals at high risk of recurrent AKI if
taken when significantly volume deplete, such as during an acute gastroenteritis, and in most
cases should be held until one can eat and drink normally; Nonsteroidal Anti-inflammatory
Drugs (NSAIDs) may exacerbate AKI risk if taken in combination with diuretics or ACE
inhibitors even when volume replete and should be completely avoided. Tailored educational
curricula surrounding these and other topics pertinent to AKI survivors may reduce recurrent
hospitalizations and lower healthcare costs. In the absence of a patient centered outpatient
approach to AKI education, the development of effective and sustainable AKI prevention
strategies remains unlikely.

Our long-term goal is to develop patient-centered educational materials to reduce AKI
recurrence. We hypothesize that a tailored educational curriculum will improve patient
awareness of potential hazards and reduce AKI recurrence among hospital-based AKI survivors.
Therefore, our overall objective for this proposal is to pilot test and evaluate the
feasibility of a patient-centered mobile health (mHealth) educational curriculum for
hospitalized AKI survivors at Duke Medical Center.

Aim 1: To test the feasibility and acceptance of a mHealth patient safety curriculum in
hospitalized AKI survivors.

Hypothesis 1: Patient safety risk awareness at 1 month will be higher in the educational
intervention arm than the usual care arm.

Aim 2: To determine if a mHealth educational curriculum improves patient safety behaviors in
AKI survivors.

Hypothesis 2: High-risk safety behaviors will be reduced at 1 month in AKI survivors
receiving the educational intervention, but not in the usual care arm.

Inclusion Criteria:

- Diagnosis of acute kidney injury as diagnosed by renal care team

- On medical or surgical services

- Over 18 year of age

- Ability to read and speak English

Exclusion Criteria:

- Legal blindness or deafness

- Pregnant

- Cognitive impairment that limits ability to consent