Medication Holds in CKD During Acute Volume-Depleting Illnesses: A Randomized Controlled Trial of a “Sick-Day” Protocol

Sick day management in people with chronic kidney disease: a scoping review

“…Of the 10 included studies, [ 17 – 25 ] eight were original articles [ 17 – 22 , 25 , 26 ], one was a letter to the editor but contained sufficient original data [ 24 ] and one was a systematic review [ 23 ]. Table 2 shows the characteristics of the included studies, while Appendix 3 provides additional study attributes such as major findings and study limitations.…”

“…Five studies (50%) explored the development, usability and/or implementation of sick day interventions and three studies (30%) focused on current practice of providing sick day management advice. A randomised controlled trial, [ 25 ] an observational primary study [ 22 ] and a systematic review [ 23 ] explored outcomes. Studies were carried out in 4 countries.…”

“…The implementation of sick day interventions likely requires more resources in the form of remuneration and overall health infrastructure Bowman et al [ 20 ] • Majority of participants found a digital tool easy to use, helpful and would recommend it to others • Participants identified story examples and guiding audio as important components to aid in understanding of sick day management • Digital education tools may be effective in educating CKD patients with low health literacy and/or older age Doerfler et al [ 24 ] • The use of index cards containing information on sick day management did not appear effective and raised concerns regarding consequences of incorrect activation leading to harm Fink et al [ 25 ] • The use of a sick day protocol coupled with an interactive voice response system to enable event reporting was associated with high engagement with participants, although this did not translate into better clinical outcomes Martindale et al [ 21 ] • As a stand-alone intervention, sick day guidance cards may have little benefit • Guidance cards should be used to supplement patient education, but HCPs reported this did not regularly occur Barriers to implementation of sick day management protocol Vicary et al [ 17 ] • Whilst half of patients who recalled receiving sick day management advice indicated they would discontinue medications when they were sick, less than 20% of patients who recalled the advice would correctly discontinue medications if they had “excessive vomiting and/or diarrhoea.” Vicary et al [ 26 ] • Around half of participants would discontinue medications during acute illness but may not cease the correct medications • More than half of participants were comfortable that they knew when to restart their medications but only 16% would restart medications after being symptom-free for 48 h per recommendations Vicary et al [ 18 ] • Pharmacists and GPs highlighted that whilst instructions seemed straightforward, they require a high level of knowledge by patients Doerfler et al [ 24 ] • Whilst most participants were able to correctly identify an index scenario where the “sick day” guidance should be applied, many patients activated the “sick day” guidance for scenarios where it was inappropriate to do so • Most participants (95%) made errors when selecting appropriate medications to discontinue during acute illness Martindale et al [ ...…”

“…One study trialled the use of a digital tool to educate patients with CKD on sick day management [ 20 ]. One of the studies used a card (a fold-over business card) containing a list of harmful medications coupled with a designated telephone number (wireless or landline) and an interactive voice response system for reporting sick day events as part of the intervention [ 25 ].…”

Optimizing Self-Management Programs in Kidney Disease: Implementation of Sick-Day Protocols

“…Fink et al address this issue by assessing the efficacy of a sick day protocol in a randomized control trial that included 315 patients with stage 3-5 CKD treated with medications that could contribute to AKI: RASi, diuretics, non-steroidal antiinflammatory drugs, or metformin. 10 Patients were randomized to usual care or an education program that consisted of two elements: (1) written educational materials that describe and define sick days and instruct patients to stop specific medications for up to 48 hours while sick and (2) an interaction voice response system (IVRS) that calls patient weekly to survey for sick-day events and assess adherence to the protocol. While the J o u r n a l P r e -p r o o f IVRS component does not deliver educational content, it serves as a reminder about the recommended sick day protocol, playing a key role in program sustainability.…”