Abstract: SA-PO051

Nephrology Follow-Up Post AKI: Effects on Outcomes and Re-Hospitalization

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Basu, Arpita, University Hospitals- Case Medical Center, Cleveland, Ohio, United States
  • Horwitz, Edward J., MetroHealth, Cleveland, Ohio, United States
  • Tarabichi, Yasir, MetroHealth, Cleveland, Ohio, United States
Background

AKI complicates 20% of all hospitalizations resulting in higher mortality, readmissions and costs. Mortality across all AKI stages is estimated at 21%. In a retrospective study, those with AKI were more likely to be rehospitalized within 30 days of discharge with cardiovascular events, mainly heart failure and acute myocardial infarction. Despite this, less than 20% of patients see a nephrologist within 3 months of discharge.

Methods

We retrospectively collected data on patients 18 years or older discharged after a hospitalization with AKI diagnosis during 1/1/14 to 12/31/16.

Data on age, sex, length of stay and discharge diagnoses by ICD-9 or 10 codes was collected and categorized into Elixhauser comorbidity classification. Data also included time to outpatient provider visit, provider specialty and time to next admission.

Cox proportional survival analysis was used to model time to readmission and death. Censoring was at 180 days post discharge or 12/31/2016. Hypothesis was tested with NephroOPTF registered as TRUE for patients having seen Nephrology versus FALSE for those seen by another specialty.

Results

4563 discharges were included, with 1534 events (readmissions or death) documented. The cox-proportional hazards model showed that of patients who saw an outpatient provider, those that saw a Nephrologist had a significant reduction in time to readmission or death compared to those that did not (adjusted hazard ratio of 0.79 [95% CI 0.65 to 0.94, p<0.001].

Conclusion

Patients with AKI if seen by a nephrologist on discharge have lower risks of death or readmission in the acute setting when compared to those evaluated by non-Nephrologists. This study is limited in its retrospective nature, but provides a model for randomized studies to better evaluate and optimize outpatient care post discharge after AKI.