SGLT2 inhibitors after acute kidney injury to improve outcomes in type 2 diabetes - PROJECT SUMMARY / ABSTRACT The safe and effective ways to care for patients after acute kidney injury (AKI) is a significant unknown in the medical field and one of growing attention. There is significant uncertainty about use of kidney-protecting medications in patients who have had AKI because many of those medications, paradoxically, reduce kidney function when initiated or resumed before their kidney-protecting qualities become apparent. This leads to deferral of therapy for many patients who have had recent AKI and other risk-factors, like chronic kidney disease (CKD) and diabetes mellitus. These patients are actually at heightened risk for multiple adverse outcomes that kidney-protecting medications prevent. Such deferrals may even become indefinite. The newest of these medication classes being impacted by these post-AKI practices are sodium-glucose cotransporter-2 (SGLT2) inhibitors, which are first-line therapy for type 2 diabetes and are known to prevent progression of CKD and cardiovascular events. Observational studies, including those published by the applicant Dr. Daniel Murphy, show favorable outcomes when SGLT2 inhibitors are provided after AKI to those with type 2 diabetes. Now Dr. Murphy seeks to translate these findings into a pilot, pragmatic, cluster-randomized clinical trial (RCT) based in primary care clinics to demonstrate the feasibility of an intervention to increase use of SGLT2 inhibitors after AKI (Aim 1). Nested within the pilot RCT, Dr. Murphy seeks to conduct a qualitative study focused on the experience of primary care providers and pharmacists and, separately, patients, within the pilot RCT. These interviews will identify barriers to prescribing, receiving, and taking a SGLT2 inhibitor and the perceived impact of our study’s intervention, which will help Dr. Murphy craft changes to the study intervention for designing a future RCT based on all his K23 results (Aim 2). In parallel with these efforts, Dr. Murphy will use electronic health record-data from patients with type 2 diabetes and AKI to determine predictors of SGLT2 inhibitor receipt, which could be used in identifying patients to recruit for a future RCT after this pilot study (Aim 3). Paired with applicable training, these research questions in this K23 Mentored Patient-Oriented Research Career Development Award will position Dr. Murphy as an independent clinical researcher equipped in both pragmatic RCT design and conduct alongside his skillset in using observational data to identify potential treatments and strategies that may improve clinical outcomes. His career will include investigating treatments to care for patients who have suffered AKI though observational and interventional means.
