Nephrology Care after Acute Kidney Injury

Patients with acute kidney injury (AKI) are at increased risk for chronic kidney disease, end-stage renal disease, and death. Researchers conducted a retrospective study to examine the rates of follow-up evaluations of patients with AKI following hospital discharge. Results were reported during a poster session at the Kidney Week 2019.

The study included all adults admitted with AKI between January 1, 2012, and December 31, 2016 to a single center in Melbourne, Australia. Inclusion criteria were baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2, survival, and free of renal replacement therapy at 30 days following hospital discharge.

The final study cohort included 702 critically ill patients with AKI. Mean age was 66 years, 64% were male, and baseline eGFR was 78 mL/min/1.73 m2. In the initial three months following discharge, only 6% of patients (n=43) received nephrology follow-up care; 9% (n=63) were reviewed within 1 year. Median time to review was 41 days.

Patients with a higher baseline creatinine, higher discharge creatinine, and a greater severity of AKI received nephrology follow-up more frequently. Referral was not prompted by traditional risk factors for chronic kidney disease, including older age and history of hypertension, diabetes, or cardiovascular disease.

“Despite international recommendations, few critically ill patients with AKI currently receive nephrology follow-up after discharge. The presence of other risk factors for chronic kidney disease was not associated with outpatient review. This represents a missed opportunity for the early detection of chronic kidney disease after AKI and prevents the timely implementation of preventative strategies to improve patient outcomes.”

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Source: See EJ, Ransely D. Incidence and predictors of nephrology follow-up after AKI in critically ill patients. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract TH-PO114), November 7, 2019, Washington, DC.