Patients discharged without proof of poor kidney function had higher mortality, ESKD risks
Click Here to Manage Email Alerts
Key takeaways:
- Patients discharged without clinical evidence of poor kidney function had an 18% higher mortality risk.
- Moreover, those individuals had a 267% increased risk for developing ESKD in 10 years.
Patients with reduced kidney function who are discharged without clinically evident residual disease had an 18% increase in mortality a year after hospitalization, data show.
Researchers led by Orly Efros, MD, MHA, of the Sheba Medical Center and Tel Aviv University in Israel, conducted a retrospective cohort study to “investigate the long-term outcomes of patients without previously diagnosed kidney disease who present with decreased kidney function and are subsequently discharged.”
The study included 40,558 adults admitted to an internal medicine ward in Israel between September 2007 and July 2022, who had not had dialysis during their hospital stay. Patients had at least three creatinine tests performed during hospitalization and an eGFR above 60 mL/min/1.73 m² on discharge. Researchers estimated eGFR from serum creatinine values with an eGFR greater than 60 mL/min/1.73 m² was considered baseline.
The association between the first and last values obtained during hospitalization was used to determine exposure. Primary outcomes were all-cause mortality in the year after the index hospitalization and end-stage kidney disease in the 10 years following hospitalization.
Among patients in the study, 85% were admitted with a normal eGFR, while 15% had a decreased eGFR compared with the baseline GFR. Those with reduced kidney function who were discharged with apparently normal kidney function faced an 18% increased mortality risk in the year following hospitalization and a 267% increased risk for developing ESKD in the course of 10 years.
“Our findings remained consistent when defining the exposure solely based on creatinine levels,” Efros and colleagues wrote, adding that risk persisted after adjusting for age, sex, background disease and treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.
It is possible that an “observed decrease in kidney function during hospitalization might reveal an existing decreased kidney reserve, unmasked by the stress of acute illness,” the researchers wrote. “Even though kidney function may seem to be recovered at discharge, the persistent reduction in kidney reserve could have long-term implications.”
Collapse
Click Here to Manage Email Alerts