A pragmatic randomized controlled trial comparing pathway-based versus usual care in community-acquired acute kidney injury.

Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC).

Is there a need for establishing a formal nephrologist-directed primary care program in dialysis units?

We have introduced an annual timetable format for addressing the "primary care" needs of the hemodialysis population. For 102 patients enrolled, fourteen interventions adapted for the dialysis population from the US Preventive Services Task Force recommendations were implemented successfully in 65% areas in our pilot year, which include important features like annual history and physical examination, breast examination, mammography, pap smear, lipid profile, adult specific immunization and stool occult blood. Flexible sigmoidoscopy program was unsuccessful in our pilot year.