Follow-up care at specialized AKI clinic shows promise for reducing rehospitalizations
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Patients who received follow-up care at a specialized clinic following AKI had a lower risk for rehospitalization than patients who received usual care, investigators from the University of Kentucky Medical Center found.
This finding, coupled with evidence from previous studies showing lower all-cause mortality for AKI survivors who were seen by a nephrologist within 90 days of discharge, led Han Ly and colleagues to suggest that post-AKI care at a clinic may present an opportunity to improve patient outcomes (the researchers further noted that nephrology follow-up has demonstrated associations with a decreased risk for cardiovascular events and sepsis).
“Currently, there are no evidence-based care practices for the evaluation and management of survivors of AKI in outpatient settings. Despite the fact that experts recommend that AKI survivors have their kidney function evaluated within 3 months of discharge to determine kidney recovery, up to one-third of AKI survivors have no measurements of kidney function within this time period, and only 6% have proteinuria assessment,” Ly and colleagues wrote. “Therefore, the development and implementation of comprehensive models of post-AKI care represent an opportunity to have a favorable impact on the evaluation and, possibly, outcomes of AKI survivors. In this context, the main objective of this study was to examine characteristics and outcomes of survivors of critical illness and AKI followed in a pilot model of an AKI clinic in reference to survivors followed under usual care.”
When comparing patients who received care at the model clinic (n = 72) with those who received usual care (n = 573), researchers determined the median time from hospital discharge to first serum creatinine evaluation was similar between groups (24.3 days vs. 17 days) and that rehospitalization at 6 months after discharge was a frequent outcome in all patients, occurring in 26.4% of survivors.
Although researchers observed no difference between groups in the time to first rehospitalization, results of a multivariable analysis showed follow-up in the AKI clinic was independently associated with a lower risk of rehospitalization/death at 6 months after discharge (adjusted OR = 0.46), with both groups experiencing rehospitalization from similar causes (notably, sepsis and cardiovascular disease).
Adjusted probabilities of rehospitalization/death at 1 month to 3 months and 3 months to 6 months were lower in patients followed at the AKI clinic compared with those who received usual care (10% vs. 16% and 8% vs. 10%, respectively).
“In conclusion, our study showed that follow-up in a specialized AKI clinic was associated with a lower risk of rehospitalization in the first 6 months post-discharge when compared to usual care in survivors of critical illness and severe AKI. We also showed that the implementation of AKI clinics may represent a feasible intervention that could potentially improve outcomes in survivors of AKI who were admitted to the intensive care units,” Ly and colleagues wrote. “Our data support conducting interventional studies to test the efficacy of AKI clinics on the prevention of rehospitalizations following discharge in high-risk groups of AKI survivors.”
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