Project Grant K23DK139456

IMPROVING PROTEINURIA TESTING AND MANAGEMENT AFTER ACUTE KIDNEY INJURY - PROJECT SUMMARY/ABSTRACT PROTEIN, ESPECIALLY ALBUMIN, IN THE URINE AFTER ACUTE KIDNEY INJURY (AKI) SIGNALS NEPHRON DAMAGE AND CAN IDENTIFY PATIENTS AT HIGH RISK OF SUBSEQUENT RENAL FUNCTION LOSS, AS WELL AS INCREASED MORBIDITY AND MORTALITY. HOWEVER, ONLY 1 IN 10 PATIENTS HAS A PROTEINURIA MEASUREMENT WITHIN 3 MONTHS OF HOSPITAL DISCHARGE. HEALTHY PEOPLE 2030 AIMS TO PROMOTE EARLY FOLLOW UP CARE AFTER AKI AND INCREASE PROTEINURIA TESTING. UNDERSTANDING THE FACILITATORS AND BARRIERS TO TESTING, IMPROVING AKI AWARENESS, AND INTEGRATING INNOVATIVE PLATFORMS TO TREAT PROTEINURIA MAY PREVENT LONG-TERM ADVERSE OUTCOMES ASSOCIATED WITH AKI. DR. Y. DIANA KWONG, A NEPHROLOGIST AT UCSF, IS A YOUNG INVESTIGATOR WHO IS COMMITTED TO DIRECTLY IMPROVING PATIENT OUTCOMES IN THOSE WITH KIDNEY DISEASE, ESPECIALLY AKI. HER PRIOR RESEARCH HAS FOCUSED ON BIOMARKERS IN KIDNEY DISEASE, AS WELL AS PATIENT REPORTED OUTCOMES AND RECOVERY AFTER AKI. THIS K23 PROPOSAL PROVIDES HER TRAINING IN QUALITATIVE METHODS FOR IMPLEMENTATION SCIENCE, LONGITUDINAL COHORT ANALYSIS USING THE ELECTRONIC HEALTH RECORD, AND CLINICAL TRIALS. THE PROPOSED PLAN WILL ALLOW FOR THE EXPLORATION, DEVELOPMENT, AND PILOTING OF STRATEGIES TO INCREASE RATES OF PROTEINURIA TESTING AND MANAGEMENT AFTER AKI AND PREPARE HER FOR A CAREER AS AN INDEPENDENT CLINICAL INVESTIGATOR. DR. KWONG HAS ASSEMBLED AN INTERNATIONALLY RENOWNED TEAM OF MENTORS COMPOSED OF: DR. KATHLEEN LIU, AN EXPERIENCED CRITICAL CARE NEPHROLOGIST AND CLINICAL TRIALIST; DR. CHI-YUAN HSU, A LEADING EXPERT IN AKI AND CKD EPIDEMIOLOGY AND OUTCOME STUDIES; DR. KIMBERLY KOESTER, AN ACADEMIC CULTURAL ANTHROPOLOGIST SPECIALIZING IN MIXED METHODS AND IMPLEMENTATION SCIENCE; AND DR. DAVID GLIDDEN, A BIOSTATISTICIAN WITH EXTENSIVE EXPERIENCE IN KIDNEY DISEASE. SHE WILL UTILIZE UCSF'S ROBUST CLINICAL AND RESEARCH RESOURCES FOR HER STUDIES AND WILL BE SUPPORTED BY THE DEPARTMENT OF MEDICINE'S DATA CORE IN ACQUIRING DATA FROM THE ELECTRONIC HEALTH RECORD TO IDENTIFY PATIENTS WITH AKI RETROSPECTIVELY AND PROSPECTIVELY. UNDER THE GUIDANCE OF HER MENTORSHIP TEAM, DR. KWONG WILL CONDUCT THE FOLLOWING AIMS. AIM 1 WILL USE SEMI- STRUCTURED INTERVIEWS OF PROVIDERS AND PATIENTS TO UNDERSTAND FACILITATORS AND BARRIERS OF PROTEINURIA TESTING. AIM 2A WILL RETROSPECTIVELY EVALUATE THE ASSOCIATION OF PHYSICIAN AWARENESS OF AKI WITH PROTEINURIA TESTING RATES WHILE AIM 2B WILL PROSPECTIVELY EVALUATE THE ASSOCIATION OF PATIENT AWARENESS OF AKI WITH PROTEINURIA TESTING RATES. AIM 3 WILL PILOT AN INTERVENTION TO MANAGE PROTEINURIA COMPARED TO USUAL CARE AT 3 MONTHS AFTER AN AKI- RELATED HOSPITAL DISCHARGE. ULTIMATELY, THIS K23 WILL PREPARE DR. KWONG FOR A SUCCESSFUL CAREER AS CLINICAL RESEARCHER FOCUSED ON IMPROVING AKI OUTCOMES. THIS CAREER DEVELOPMENT AWARD WILL NATURALLY LEAD TO AN NIDDK R01 APPLICATION FOR A LARGER TRIAL ON PROTEINURIA MANAGEMENT IN PATIENTS AFTER AKI. INCREASED IDENTIFICATION AND MANAGEMENT OF PATIENTS WITH PROTEINURIA AFTER AKI MAY REDUCE LONG-TERM ADVERSE OUTCOMES AND IMPROVE THE SURVIVAL OF AKI PATIENTS.