Discharge Documentation and Follow-Up of Critically Ill Patients With Acute Kidney Injury Treated With Kidney Replacement Therapy: A Retrospective Cohort Study

Abstract

Leading organisations recommend follow-up of acute kidney injury (AKI) survivors, as these patients are at risk of long-term complications and increased mortality. Information transfer between specialties and from tertiary to primary care is essential to ensure timely and appropriate follow-up. Our aim was to examine the association between completeness of discharge documentation and subsequent follow-up of AKI survivors who received kidney replacement therapy (KRT) in the Intensive Care Unit (ICU). We retrospectively analysed the data of 433 patients who had KRT for AKI during ICU admission in a tertiary care centre in the UK between June 2017 and May 2018 and identified patients who were discharged from hospital alive. Patients with pre-existing end-stage kidney disease and patients who were transferred from hospitals outside the catchment area were excluded. The primary objective was to assess the completeness of discharge documentation from critical care and hospital; secondary objectives were to determine cardiovascular medications reconciliation after AKI, and to investigate kidney care and outcomes at 1 year. The development of AKI and the need for KRT were mentioned in 85 and 82% of critical care discharge letters, respectively. Monitoring of kidney function post-discharge was recommended in 51.6% of critical care and 36.3% of hospital discharge summaries. Among 35 patients who were prescribed renin-angiotensin-aldosterone system inhibitors before hospitalisation, 15 (42.9%) were not re-started before discharge from hospital. At 3 months, creatinine and urine protein were measured in 88.2 and 11.8% of survivors, respectively. The prevalence of chronic kidney disease stage III or worse increased from 27.2% pre-hospitalisation to 54.9% at 1 year (p < 0.001). Our data demonstrate that discharge summaries of patients with AKI who received KRT lacked essential information. Furthermore, even in patients with appropriate documentation, renal follow-up was poor suggesting the need for more education and streamlined care pathways.

Long-term outcomes in patients who received veno-venous extracorporeal membrane oxygenation and renal replacement therapy: a retrospective cohort study

“…As proposed for critically ill patients in general, AKI aftercare for ECMO patients requires a collaborative multidisciplinary effort by all teams involved, including intensivists, nephrologists, internists, GPs and pharmacists [ 36 ]. To facilitate this, comprehensive discharge documentation and information transfer are essential [ 37 ]. The hospital discharge summary should not only contain primary events such as AKI cause, staging and RRT receipt, but also recommendations for future management such as nephrotoxin avoidance, weight and blood pressure monitoring, cardiovascular medication management, and sick day rules.…”

Cardiac Surgery Associated AKI Prevention Strategies and Medical Treatment for CSA-AKI

“…Current evidence supports a multimodal risk-stratification approach, including goal-directed perfusion, the use of biocompatible coatings during CPB, perioperative GDT, the use of balanced fluids with restricted chloride content, and biomarker-guided postoperative management of high-risk patients based on the recommendations of the KDIGO group. If AKI occurs, the transfer of information to all caregivers, medication reconciliation and patient education are essential to reduce the risk of long-term complications [115].…”

Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events

“…Despite the link between AKI and CKD, information about AKI (even for those patients with a need for RRT) is not always provided in the discharge documentation, which makes it difficult for primary care doctors to improve their kidney function follow-up. This issue was recently reviewed by Ostermann et al (6). Among the AKI patients who received RRT in intensive care units (ICUs) in the UK, the development of AKI and the need for RRT were mentioned in 85% and 82% of critical care discharge letters, respectively, and the monitoring of kidney function post discharge was recommended in only 36.3% of hospital discharge summaries (6).…”

“…This issue was recently reviewed by Ostermann et al (6). Among the AKI patients who received RRT in intensive care units (ICUs) in the UK, the development of AKI and the need for RRT were mentioned in 85% and 82% of critical care discharge letters, respectively, and the monitoring of kidney function post discharge was recommended in only 36.3% of hospital discharge summaries (6).…”