Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors

Abstract

Survivors of severe acute kidney injury remain at high risk of death well after apparent recovery from the initial insult. Here we determine whether early nephrology follow-up after a hospitalization complicated by severe acute kidney injury associates with patient survival. This consisted of a cohort study of all hospitalized adults in Ontario from 1996 to 2008 with acute kidney injury who received temporary inpatient dialysis and survived for 90 days following discharge independent from dialysis. Propensity scores were used to match individuals with early nephrology follow-up, defined as a visit with a nephrologist within 90 days of discharge, to those without. The outcome was time to all-cause mortality of 3877 patients who met the eligibility criteria within a maximum follow-up of 2 years. A total of 1583 patients had early nephrology follow-up of whom 1184 were successfully matched 1:1 to those not receiving early follow-up. The incidence of all-cause mortality was lower in those patients with early nephrology follow-up compared with those without (8.4 compared with 10.6 per 100-patient years, hazard ratio 0.76 (95% CI: 0.62-0.93)). Thus, early nephrology follow-up after hospitalization with acute kidney injury and temporary dialysis was associated with improved survival. This finding requires definitive testing in a randomized controlled trial.

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…Studies indicate that most survivors of AKI are not cared for by nephrologists [89][90][91][92] . Although data derived largely from observational cohort studies suggest that referral to nephrology care is associated with improved survival 93 , causality remains to be proven and the elements of care that drive this potential benefit have not been identified. Identifying the driver(s) of beneficial outcomes is of critical relevance as rapid growth in the incidence of AKD means that most survivors will be cared for initially by primary care physicians.…”

Predictors of Recurrent AKI

“…12 Subsequent studies suggest that referral may benefit survivors of dialysis-requiring AKI. 37 However, better understanding of the care driving this potential benefit and a more efficient approach to identify high risk patients are needed. This may be especially appropriate during the first 3-4 months following discharge from AKI, when most of the recurrent AKI seems to occur.…”

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

“…Despite these concerns and the recommendations of international guidelines (6), survivors of critical illness complicated by AKI rarely receive specific renal follow-up (7), despite potential benefit (8), and the true prevalence of CKD in this group is not well understood. Importantly, calculation of eGFR (9) has not been calibrated in survivors of critical illness, which is associated with substantial and persistent decrease of muscle mass (the site of creatinine generation) (10).…”