Study: Post-hospital discharge care falls short in Canada for patients with AKI
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Key takeaways:
- In the study, 21.2% of hospitalized patients with preexisting CKD saw a nephrologist within 90 days post-discharge.
- Among patients with AKI, 76.3% saw a general practitioner during the same period.
The percentage of patients in Alberta, Canada, who received optimal care after an AKI episode was low and may signal a need to improve outcomes, according to a recently published study.
“Hospital-acquired AKI is associated with a high risk of adverse long-term outcomes, including recurrent AKI, progression to chronic kidney disease (CKD), kidney failure requiring dialysis, cardiovascular events, hospital re-admission and death,” Sandeep Brar, MD, of the department of epidemiology and biostatistics at the University of California, San Francisco, and colleagues wrote. “We sought to examine these processes of care after discharge in survivors of hospitalized AKI.”
Researchers conducted a population-based retrospective cohort trial that examined 23,921 adults admitted to a hospital in Alberta between 2009 and 2017. Investigators followed participants until 2019, with a median follow-up of 2.7 years. The authors analyzed cumulative incidence curves to determine the proportion of patients who received each outcome within the first 90 days and subsequent 1-year follow-up. Post-discharge outcomes were the rate of participants who had a kidney function evaluation, who were evaluated by a specialist or practitioner, and who received prescriptions for treating CKD.
Within 90 days after hospital release, 21.2% of patients with preexisting CKD and 8.6% of those without preexisting CKD saw a nephrologist, according to the findings. During the same period, 76.3% and 74.9% of patients with AKI and preexisting CKD and those with AKI but without preexisting CKD, respectively, saw a general practitioner.
A total of 60% of patients with AKI had at least one serum creatinine measurement, and 25.5% had an albuminuria test. In addition, 52.7% of patients with AKI and preexisting CKD, as well as 51.6% of patients with newly developed CKD, were prescribed a renin-angiotensin-aldosterone system inhibitor within 4 months to 15 months after discharge.
“CKD management in these patients appeared to fall short of the standard of care achieved for other groups of patients with CKD,” according to the researchers. “Changes to health care delivery are required to close these gaps and improve outcomes for patients after an episode of AKI.”
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