Hospitalized patients with acute kidney injury may not be receiving sufficient care after discharge

Acute kidney injury (AKI) is the most common in-hospital diagnosis seen by U.S. nephrologists, but patients with the condition may not be receiving sufficient follow-up care, according to a new study. The findings of the study, “The Daily Burden of Acute Kidney Injury: A World Kidney Day Survey of U.S. Nephrologists” (Abstract 1444), will be presented at ASN Kidney Week 2013.

Researchers led Jay Koyner, MD, from the University of Chicago, sought to estimate the extent of in-hospital and outpatient nephrology care devoted to the care of patients with AKI. On World Kidney Day, they conducted an internet-based survey of all 4,957 U.S.-based physician members of the American Society of Nephrology.

The team received survey responses from 598 nephrologists. About half of the nephrologists worked in a teaching hospital with a median of 398 beds. Among the survey’s major findings:

Respondents saw a median of 12 patients in the hospital compared with eight patients seen in clinics.
A median of four patients seen in the hospital had pre-existing kidney failure while five patients had AKI.
Most patients seen in the hospital had AKI, comprising 46% (1500 patients) of the sample, followed by kidney failure (38%, or 1233 patients).
Among patients seen in the hospital for AKI, a median of two were critically ill, and one required renal replacement therapy, which includes dialysis or a kidney transplant.
Among patients seen in clinics, a median of one patient was seen for follow-up of in-hospital AKI; 55% of physicians reported that in the prior year, less than10% of patients seen in the clinic were for follow-up of in-hospital AKI.

The findings indicate that AKI is the most common in-hospital diagnosis seen by U.S. nephrologists. Also, patients with AKI are often critically ill, but survivors of in-hospital AKI do not comprise a large part of nephrologists’ outpatient clinic encounters. “These findings call for continued efforts to promote excellence in the delivery of renal replacement therapy to patients with AKI, and reliable transition of care services following hospital discharge from an AKI episode,” the investigators wrote.

Disclosures: Jay L. Koyner is listed on a patent for Pi GST to detect severe AKI following cardiac surgery with Argutus Medical. Jorge Cerda is a consultant for Gambro, Cytopherex, and Reata Pharmaceuticals; and receives research funding from Alere Pharmaceuticals, Gambro, and Cytopherex; and honoraria from Gambro. Stuart Goldstein is a consultant for Gambro Renal Products, Baxter Healthcare, Hemametrics, Otsuka, and Ikaria; has an ownership interest in Hemametrics, Inc.; and receives research funding and honoraria from Gambro Renal Products and Baxter Healthcare. Kathleen D. Liu is a consultant for Astute, Complexa, Cytopheryx, Chemocentryx, Abbvie; holds in Amgen; and receives honoraria from ASN.

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