Abstract: FR-PO001
Significant Numbers of Hospitalized Patients with AKI Are Seen in Primary Care Before Admission, Representing Opportunities for Early Intervention
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Riding, Alexandra, East and North Herts NHS Trust, Stevenage, United Kingdom
- Berresford, Kate, East and North Herts NHS Trust, Stevenage, United Kingdom
- Morlidge, Clare, East and North Herts NHS Trust, Stevenage, United Kingdom
- Mathavakkannan, Suresh, East and North Herts NHS Trust, Stevenage, United Kingdom
- Findlay, Andrew, East and North Herts NHS Trust, Stevenage, United Kingdom
Background
Acute kidney injury (AKI) confers increased morbidity and mortality and e-alerts are evenly distributed between hospital and community settings (Holmes et al, CJASN, 2016). Primary care physicians (PCPs) are well-placed to enact sick-day guidance, forming a critical juncture to reduce potential hospital admission, length of stay and emergency intervention. PCPs make decisions with limited time and information, hampering adherence to ‘Think Kidneys’ guidance (UK Renal Registry, Renal Association). In light of recent advice balancing the opposing risks of ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) cessation during AKI on cardiorenal outcomes, greater support from renal services at the primary/secondary care interface is required to effectively manage these patients (Thomson & Tomlinson, CJASN, 2019 and Clark et al, Heart, 2019).
We sought to determine the proportion of patients with AKI, who might benefit from advice in primary care.
Methods
Retrospective data were collected on hospitalized patients (Nov 2018-May 2019) identified by elevated serum creatinine results (as per national AKI reporting guidance). Data sources were patient records and computerized reporting systems.
Results
150 patients were identified (data available for 148). 38/148 (26%) saw a PCP in the fortnight pre-admission (11/38 subsequently referred) and 27/148 (18%) were referred by a PCP to hospital. 41/148 (28%) were inpatients in the preceding month and 48/148 (32%) were care home residents.
Conclusion
A quarter of patients saw a PCP before admission, representing an opportunity to intervene. Patients were elderly and co-morbid therefore decisions involving medication cessation and cardiovascular review require specific expertise and training, through enhanced physician relationships. Better community support and admission avoidance may represent the best possible medical care for some patients and urgent improvement in links between primary care and secondary renal service is recommended for all.
AKI risk factors by stage
| AKI | Stage 1 (n=58) | Stage 2 (n=58) | Stage 3 (n=32) | All AKI (n=148) |
| Age (median years) | 82 | 83 | 78 | 82 |
| History of CKD (%) | 30 (52) | 22 (38) | 12 (38) | 64 (43) |
| Previous AKI (%) | 19 (33) | 24 (41) | 13 (41) | 56 (38) |
| Prescribed ACEi/ARB (%) | 18 (31) | 22 (38) | 11 (34) | 51 (34) |