#4573 IMPACT OF A REMOTE PATIENT MONITORING ON UNPLANNED READMISSIONS IN ACUTE KIDNEY INJURY SURVIVORS
Authors: Charkviani Mariam , Kattah Andrea , Ferguson Jennifer , Kashani Kianoush , May Heather , Philpot Lindsey , Rosedahl Jordan , Rule Andrew , Barreto Erin 
Published: June 2023

Abstract

Background and Aims
At least 30% of acute kidney injury (AKI) survivors lack appropriate follow up after hospital discharge. AKI survivors have highly dynamic posthospital course which warrants close monitoring to prevent adverse outcomes. Digital health solutions like remote patient monitoring (RPM) could be used to improve quality and efficiency of AKI survivor care. The purpose for this study was to assess the feasibility and effectiveness of the Mayo Clinic AKI RPM program, launched in October 2021.

Method
The Mayo Clinic AKI RPM program enrolled individuals who experienced AKI during a hospitalization and underwent nephrology consultation (Figure 1). Feasibility was assessed as the proportion of individuals approached for AKI RPM enrollment during the first year of the program who submitted at least one set of vital signs after discharge. An effectiveness analysis compared stage 3 AKI survivors enrolled in AKI RPM with at least 30-days of follow-up to matched historical controls (3:1) sampled from before RPM was available (2018-2021). The primary endpoint was hospital readmission or emergency department (ED) visit within 30-days, assessed with the Chi-square test. Secondarily we explored time to first readmission or ED visit with a Kaplan-Meier survival curve with a non-parametric comparison between groups, as well as readmission length of stay with the Wilcoxon Rank Sum test due to right skewed data distribution.

Results
Of the 50 individuals approached for AKI RPM participation, 45 (90%) submitted at least one set of vitals. Among AKI RPM patients, 34 patients with stage 3 AKI were matched to 102 controls based on baseline characteristics and demographics. Dialysis during hospitalization (liberated by discharge) was used in 36 (27%) of patients. Sixty (44%) individuals required ICU level of care. Median (IQR) discharge estimated glomerular filtration rate was 15 (11, 27) mL/min/1.73m2. Through matching, groups were well balanced with respect to pertinent baseline demographics. Hospital readmission or ED visit occurred in 17 (50%) of AKI RPM patients within 30-days compared to 39 (38%) of controls within 30-days (P = .23). The endpoint appeared driven by ED visits within 30-days, not readmissions [At least one ED visit: 13 (38%) vs 21 (21%), respectively (P = .04); At least one hospital readmission: 7 (21%) vs 26 (26%), respectively (P = .56)]. Time to first readmission or ED visit within 30-days was similar between groups (P = .35; Figure 2). Among the 33 patients who were readmitted to the hospital within 30-days, readmission length of stay was similar in the AKI RPM group compared to controls [Median (IQR) 76 (10.6, 121) hours vs 108 (70, 165) hours); P = 0.33].

Conclusion
In conclusion, AKI RPM was a feasible program when used to bridge the care continuum (hospital to home) in non-dialysis dependent AKI survivors. Incidence of at least one hospital readmission or ED visit within 30-days was statistically similar between AKI RPM patients and controls. More AKI RPM patients experienced ED encounters in the 30-days after discharge, but frequency of hospital readmission was similar. Digital health solutions such as RPM offer a unique opportunity to address the important gap in AKI care after discharging from the hospital. Additional research is needed to explore the impact of AKI RPM on patient outcomes.