ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: SA-PO542

AKI Outcomes as a Quality Paradigm: A Health Systems Approach

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Gudsoorkar, Prakash Shashikant, University of Cincinnati, Cincinnati, Ohio, United States
  • Modi, Jwalant R., University of Cincinnati, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States

Acute kidney injury (AKI) affects 1-in-3 hospitalized patients; survivors face long-term consequences including high risk of re-admissions, end-stage renal disease (ESRD), or mortality. Retrospective studies estimate that only 15-20% of patients receive follow-up renal care within one year of discharge. At a large tertiary care health system, we operationalized and implemented a quality improvement program (QIP) to track discharge disposition and post-discharge follow-up renal care of all AKI consults.


By combining billing data and health-system wide informatics, we considered all non-ESRD, non-transplant hospitalizations receiving renal consults for each calendar quarter. The first hospitalization with an AKI renal consult in each quarter was considered as the index event. Discharge dispositions included expired/hospice, inter-facility transfers (long-term acute care/acute care), home with self-care or home-health, nursing home, and others. All survivors except inter-facility transfers were considered eligible for renal follow-up metric defined as any renal contact within 90-days of discharge (office visits, chronic dialysis visits, or renal follow-up during readmission). We also tracked all-cause 90-day re-admissions. Chi-square and Kruskal-Wallis test was used for comparison across quarters.


Between 10/2015 and 12/2017 (9 quarters) we identified 2,383 AKI consults (60% male, 64% White). Overall, 22% expired/discharged to hospice (18% to 25% across quarters; p = 0.70); 12% inter-facility transfers; and 66% were eligible for renal follow-up metric (23% home with self-care; 18% home with home-care; 23% rehab-nursing home; 2% others). Of the eligible patients, 42% met the metric (range from 39% to 49% across quarters p=0.09); renal office visits occurred in 29% (range across quarters 22% to 37%), with a median time to renal visit of 31 days (q1, q3, 18, 49). Overall 90-day re-admission rate was 40% (range 35 to 46% across quarters; p=0.29), with median time to re-admission of 17 days (q1, q3, 7, 42).


This is the first report of operationalizing system-wide AKI metrics in real-time and can inform optimal strategies to improve post-discharge care in AKI. Such informatics-based QIP have the potential to plan and implement targeted resource allocation and improve patient and process outcomes.


  • Clinical Revenue Support