No association between interactive voice response system, improved kidney outcomes
Click Here to Manage Email Alerts
Patients with stage 3 to 5 chronic kidney disease who used an interactive voice response system did not experience significant changes in kidney outcomes compared with patients who received usual care.
However, patients rated the system highly.
“Angiotensin aldosterone system (RAAS) blockers and diuretics are cornerstone therapies in CKD. The benefits of these drugs may be offset by adverse effects in conditions, such as volume depletion where kidney autoregulation is impeded with RAAS blockade,” Jeffrey C. Fink, MD, from the department of medicine at the University of Maryland School of Medicine, and colleagues wrote. “‘Sick days’ with volume depletion related to nausea, vomiting or diarrhea are not unusual in CKD and can potentially transform RAAS blockers and diuretics from salutary to harmful exposures, and increase susceptibility to hypotension, diminished glomerular filtration rate, AKI and other adverse events, such as hyperkalemia.”
In a 6-month pragmatic trial, investigators examined 315 veterans with stage 3 to 5 CKD treated with a renin angiotensin aldosterone inhibitor blocker, diuretic, NSAID or metformin. Researchers randomized patients to either sick-day protocol (n= 159) or usual care groups (n=156) with the aim of measuring a change in kidney outcomes, incidence of AKI based on ICD-10 codes and ambulatory lab testing, urgent service utilizations and sick days.
All patients were given a script describing a sick-day event and were told to receive a pre-ordered blood test for a kidney function panel at baseline and 6 months, and during, or soon after, any sick-day event.
Those randomized to sick-day protocol received a card with instructions on how to react to a sick day, in addition to a pamphlet with instructions for holding and resuming reference drugs. These patients also scheduled weekly calls from an automated interactive voice response system to survey for sick-day events. Patients could self-initiate a call if a sick day occurred between the scheduled calls and completed the survey each week.
Researchers identified the mean change in GFR from baseline to the 6-month follow-up as –0.71 mL/min/1.73 m2 among the sick-day protocol group and –0.72 mL/min/1.73 m2 among the usual care group. Analyses revealed hospitalizations in the sick-day protocol group were 11.5 per 100 events per person-months and 8.4 per 100 events per person-months in the usual care group.
Those in the sick-day protocol group participated in the interactive voice response system in 81% of expected weeks, and of the 33 true sick days, patients correctly followed the protocol for 14 days.
“When examining interactive voice response system participation and success of implementation of the self-management sick-day protocol, we observed high rates of engagement but a notable frequency of errors in interactive voice response system use, identification of qualifying sick days, and proper protocol execution. Common missteps included erroneous reporting of sick days, failure to hold pre-specified medications or stopping the incorrect medicines during qualifying sick days,” Fink and colleagues wrote. “Despite these errors, all participants still rated the system and sick-day protocol highly with potentially misguided confidence about its use.”
Collapse
Read more about
Click Here to Manage Email Alerts