Transitional Care for Patients with Chronic Kidney Disease

Purpose: The purpose of this study is to pilot test the effectiveness of a medication information management transitional care intervention following hospital discharge among patients with chronic kidney disease (CKD).  Specifically, this presentation will focus on describing the design, baseline characteristics of participants, and preliminary results of the “Medication Intervention in Transitional Care to Optimize Outcomes for Chronic Kidney Disease” Clinical Trial.  

Background: Patients with CKD have more co-morbidities, are hospitalized more often and for longer lengths of stay, and incur greater healthcare costs than patients with other chronic conditions.  Patients with CKD are less likely to receive evidence-based therapies when hospitalized and commonly have complex drug regimens and adverse events which contribute to poor outcomes.  The current state of knowledge largely concerns risks of CKD associated with discreet episodes of hospitalization. Among survivors, little is known about strategies to improve the transition from hospital-to-home or how to favorably impact outpatient management, health outcomes, costs, and risks of hospital readmission or death. Enhanced transitional care interventions have been shown to improve medication information transfer, reduce hospital readmissions, and slow the progression of declining health in the general population of hospitalized patients. Interventions that prevent or slow CKD progression such as blood pressure control with angiotensin converting enzyme (ACE) inhibition or angiotensin-2 receptor blockade (ARB) and intensive glycemic control in patients with diabetes are all highly dependent on meticulous medication management following hospital discharge

Methods: A single-center, randomized controlled clinical trial tested the hypothesis that improved medication information transfer (MIT) through a home-based pharmacist-led intervention with in the first week of discharge, would reduce readmissions and visits to the emergency room or urgent care for 90 days. Participants (n=140) were recruited during hospitalization and then randomized to usual care or the MIT intervention.

Results: The poster presentation will describe baseline characteristics of participants, common medication problems identified in the intervention group, and interventions implemented. Of the first 115 enrolled, the most common reasons for the index hospitalization were cardiovascular diseases (33%, 38/115), infections (21%, 24/115), and acute kidney injury (11%, 13/115). Participants’(n=115) mean age (±SD) was 70±11 years, 47% (54/115) were women, and mean estimated glomerular filtration rate (eGFR, CKD-EPI) was 41±13 ml/min/1.73m².

Implications: The CKD-MIT clinical trial will determine the effectiveness of an early home-based pharmacy intervention focused on reducing rates of acute care use and risk factors for CKD progression and associated complications.