Study: 25% of patients with AKI received proper follow-up after hospital discharge
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Key takeaways:
- Overall, 25% of patients received recommended follow-up work within 3 months post-discharge.
- Additionally, 4% of patients saw a nephrologist within 3 months of leaving the hospital.
One in four patients who were critically ill with AKI received proper follow-up care within 3 months after hospital discharge, according to recently published data.
“Kidney injury in the ICU is usually managed by ICU doctors, not kidney doctors,” lead researcher Rachel Jeong, in the division of nephrology at the University of Calgary, and colleagues, wrote. “When patients get better and goes home, they may never see a kidney doctor, even if there is still kidney damage.”
In the retrospective cohort study, researchers studied how often patients have follow-up work, including serum creatinine and urine protein measurements, to check their kidney health after they return home. The study included 29,732 patients admitted to the ICU with AKI in Alberta, Canada, from 2005 to 2018, who were discharged without kidney replacement therapy or who had an eGFR of less than 15 mL/min/1.73 m2.
Primary outcomes were the incidence of an outpatient serum creatinine and urine protein measurement at 3 months post-discharge. Secondary outcomes included incidence of outpatient serum creatinine and urine protein measurements or outpatient visits to patients’ family physicians, internists, nephrologists or cardiologists within 3 months post-discharge.
Researchers found that although most patients had a family physician visit by 3 months post-discharge, many did not have an outpatient serum creatinine or outpatient urine protein measurement. Overall, 25% of patients received both measurements after leaving the hospital.
A total of 64% of patients had only an outpatient creatinine measurement 3 months post-discharge with a median time of 37 days after discharge, and 27% of patients received an outpatient urine protein measurement with a median time of 181 days.
Nephrology follow-ups were also rare, according to the study. The cumulative rate of an outpatient visit to a family physician, nephrologist, internist and cardiologist were 89%, 4%, 28% and 29%, respectively. For death, kidney replacement therapy and rehospitalization at 3 months, the rates of occurrence were 4%, 0.09% and 25%, respectively.
“Survivors of critical illness often have multiple hospital providers outside of the ICU before hospital discharge, which may be a barrier to effective transition of care from the hospital to the community,” Jeong and colleagues wrote. “Enhanced follow-up of AKI survivors may improve outcomes in this vulnerable population.”
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