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Abstract: FR-PO1081

Outpatient Follow-Up After AKI in the Pediatric Intensive Care Unit (PICU)

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Robinson, Cal, McMaster Children's Hospital, Hamilton, Ontario, Canada
  • Hessey, Erin, University of Alberta Faculty of Medicine, Montreal, Alberta, Canada
  • Nunes, Sophia, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Dorais, Marc, StatSciences Inc., Montreal, Quebec, Canada
  • Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
  • Zappitelli, Michael, The Hospital for Sick Children, Toronto, Ontario, Canada
Background

Although KDIGO AKI guidelines recommend re-evaluation at 3 months, few studies have characterized pediatric AKI follow-up. This information is needed to target knowledge translation to enhance post-AKI care. Aims: 1) Describe outpatient follow-up of children with PICU-AKI; 2) Determine factors associated with nephrology follow-up in AKI patients.

Methods

Two-center retrospective cohort study (PICU admissions ≥2 days from 2003-2005; children 0-18 years old surviving hospitalization; non-cardiac surgery; no baseline kidney disease). Provincial administrative databases used to determine outcomes (until 2010). Exposure: AKI (KDIGO serum creatinine and urine output definition). Primary outcome: outpatient nephrology (Neph) visit by 1 yr post-discharge. Secondary outcomes: a) family physician (FP) or pediatrician (Ped), b) FP, Ped or non-Neph specialist (Spec) visits. Univariable analyses used to compare outcomes by AKI stage and evaluate patient factors associated with 1-yr Neph follow-up.

Results

Of n=2041, 355 (17%) had AKI: 64/355 (18%), 198 (56%) and 338 (95%) had Neph, FP or Ped and FP, Ped or Spec follow-up by 1 yr post-discharge. Figure: Children with AKI were more likely to have Neph follow-up (p<0.0001). There was no AKI vs. non-AKI difference in follow-up for other physicians (p>0.05). 44/142 (31%) stage 2-3 AKI patients had Neph follow-up by 1 yr. Factors associated with 1-yr Neph follow-up in AKI patients were: longer hospital stay; AKI stage 2-3; dialysis receipt; discharge SCr >1.5x baseline (all p<0.0001).

Conclusion

Children with PICU-AKI are more likely to receive Neph follow-up, though follow-up is suboptimal for severe AKI. Non-Neph physician follow-up is very high, suggesting AKI follow-up knowledge translation strategies for non-Neph providers should be a priority.

Figure. Time to outpatient nephrology (Neph) visit after PICU hospitalization, by AKI status

Funding

  • Private Foundation Support