A Survey Study of Self-Rated Patients’ Knowledge About AKI in a Post-Discharge AKI Clinic

Abstract

Background: Survivors of acute kidney injury (AKI) are at risk of adverse outcomes. Post-discharge nephrology care may improve patients’ AKI knowledge and prevent post-AKI complications. Objective: The purpose of this study was to examine patients’ awareness about their AKI diagnosis and self-rated knowledge and severity of AKI before and after their first post-discharge AKI Clinic encounter. Design: We conducted a pre- and post-survey study among AKI survivors who attended a post-discharge AKI Clinic. Setting: AKI Clinic at the University of Kentucky Medical Center (October 2016 to December 2017). Education about AKI was based on transformative learning theory and provided through printed materials and interdisciplinary interactions between patients/caregivers and nurses, pharmacists, and nephrologists. Patients: A total of 104 patients completed the survey and were included in the analysis. Measurements: Three survey questions were administered before and after the first AKI Clinic encounter: Question 1 (yes-no) for awareness, and questions 2 and 3 (Likert scale, 1 = lowest to 5 = highest) for self-rated knowledge and severity of AKI. Methods: Two mixed-model analysis of variance (ANOVA) was used for between-group (AKI severity) and within-group (pre- and post-encounter) comparisons. Logistic regression was used to examine parameters associated with the within-group change in self-perceived knowledge. Results: Twenty-two out of 104 (21%) patients were not aware of their AKI diagnosis before the clinic encounter. Patients’ self-ratings of their AKI knowledge significantly increased after the first AKI Clinic encounter (mean ± SEM: pre-visit = 1.94 ± 0.12 to post-visit = 3.88 ± 0.09, P = .001), even after adjustment for age, gender, Kidney Disease Improving Global Outcomes (KDIGO) severity stage, or poverty level. Patients with AKI stage 3 self-rated their AKI as more severe than patients with AKI stage 1 or 2. Limitations: Our study population may not be representative of the general AKI survivor population. Administered surveys are subject to response-shift bias. Conclusions: Patients’ self-perceived knowledge about AKI significantly increased following the first post-discharge AKI Clinic encounter that included interdisciplinary education. This is the first survey study examining self-perceived AKI knowledge in AKI survivors. Further examination of AKI literacy in survivors of AKI and its effect on post-AKI outcomes is needed. Trial registration: Not applicable.

Long-Term Outcomes in Patients with Acute Kidney Injury

“…Considering the high incidence of AKI and improvements in short-term survival (74), these long-term sequelae of AKI present a major unmet clinical need, with no proven interventions or data to inform optimal care provision. Patients often receive no follow-up after hospital discharge (16), and they often do not realize that they have had AKI (71,75). The evidence base describing the long-term sequelae of AKI continues to grow, adding to our understanding and increasing awareness of these issues.…”

What Do Acute Kidney Injury Survivors Want to Know About Their Condition: A Qualitative Study

“… 12 , 19 , 20 There is mounting evidence that tailored postdischarge AKI clinics serve an important role in improving AKI knowledge and self-management behaviors. 21 , 22 …”

“…[19][20][21] There is mounting evidence that J o u r n a l P r e -p r o o f tailored post-discharge AKI clinics serve an important role in improving AKI knowledge and self-management behaviors. 22,23 We surmise that optimal interventions for patient-centered AKI care must target care components in the inpatient and outpatient settings, and across care transitions with the fundamental goals of increasing awareness of AKI, improving education and communication regarding AKI causes and self-management practices, and documentation of AKI in the medical record and in patient-facing materials. In Table 3, we outline recommendations for patient-centered AKI care best practice activities across care settings based on challenges identified in our work.…”

Characteristics and Outcomes of Survivors of Critical Illness and Acute Kidney Injury Followed in a Pilot Acute Kidney Injury Clinic

“…Surprisingly, 80% of AKI survivors were unaware of their condition by the time of discharge, and 21% were unaware of their AKI diagnosis at the first AKI Clinic visit. 5 , 6 The AKI survivors were also shown to be at higher risk for rehospitalization than their counterparts without AKI. A population-based study showed that 18% of AKI survivors were readmitted within the first 30 days of discharge.…”