Abstract: TH-PO114
Incidence and Predictors of Nephrology Follow-Up After AKI in Critically Ill Patients
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- See, Emily J., Austin Health, Melbourne, Victoria, Australia
- Ransley, David, Austin Health, Melbourne, Victoria, Australia
Background
Acute kidney injury (AKI) is a common complication of critical illness, and survivors are at increased risk of chronic kidney disease, end-stage kidney disease, and death. International guidelines have recommended that patients with AKI are evaluated after hospital discharge to assess for complications; however, follow-up rates have been reported to be low, and they have never been studied in critical care or Australian settings.
Methods
We conducted a retrospective study of all critically ill adults admitted with AKI between 1 January 2012 and 31 December 2016 to a single centre in Melbourne, Australia. Eligible patients were required to have a baseline eGFR >30 mL/min/1.73m2 and to be alive and independent of renal replacement therapy at 30 days after hospital discharge. Logistic regression models were used to examine the primary outcome, which was nephrology review within the first year. Candidate predictors were screened for inclusion using univariable models and a backward stepwise elimination approach was used to remove covariates whose multivariable p value was >0.2.
Results
A total of 702 critically ill patients with AKI were included in the study (mean age 66 years, 64% male, baseline eGFR 78 mL/min/1.73m2). Only 43 patients (6%) received nephrology follow-up in the first 3 months, while 63 patients (9%) were reviewed within a year. The median time to review was 41 days (interquartile range 23-136). Nephrology follow-up occurred more frequently in patients with a higher baseline creatinine (OR 1.02, 95% CI 1.01-1.03), a higher discharge creatinine (OR 1.01, 95% CI 1.01-1.02), and a greater severity of AKI (stage 3 OR 3.26, 95% CI 1.50-7.10). Traditional risk factors for chronic kidney disease, including older age and a history of hypertension, diabetes, or cardiovascular disease, did not prompt referral.
Conclusion
Despite international recommendations, few critically ill patients with AKI currently receive nephrology follow-up after discharge. The presence of other risk factors for chronic kidney disease was not associated with outpatient review. This represents a missed opportunity for the early detection of chronic kidney disease after AKI and prevents the timely implementation of preventative strategies to improve patient outcomes.