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Kidney Week

Abstract: PO0048

Trends in Nephrology Follow-Up After an Episode of AKI in US Veterans

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Sohaney, Ryann, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Mhanna, Houssam, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Yin, Maggie, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Shahinian, Vahakn, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Hsu, Raymond K., University of California San Francisco, San Francisco, California, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Zivin, Kara, University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Heung, Michael, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
Background

KDIGO guidelines recommend evaluating patients following AKI for new onset or worsening CKD. Yet, historically nephrologist referral post-AKI has been low. We sought to determine recent trends in outpatient nephrologist follow-up after a hospitalization with AKI.

Methods

We assembled a national cohort of US veterans surviving 30-days post hospitalization with KDIGO creatinine-defined AKI from 2008 to 2017, excluding those with ESRD or kidney transplant, those requiring dialysis within 30 days of hospital discharge, or discharged to hospice. The primary outcome was the proportion of AKI survivors completing an outpatient visit with a nephrologist within 6 months of their AKI hospitalization. To assess trends, we assessed the association of year (as a continuous variable) with follow-up in a Cox proportional hazards model adjusting for age, race, sex, AKI stage, hypertension, diabetes, CKD, Charlson Comorbidity Index, ICU utilization, acute myocardial infarction, acute heart failure, and hospital admitting service.

Results

Of the 480,200 survivors of AKI, 12.2% had a visit with a nephrologist within 6 months. The proportion of patients with nephrology follow-up ranged from 10.0% in stage 1 AKI to 43.8% in patients with AKI requiring inpatient dialysis. The proportion of patients receiving post-AKI care increased across the study period, from 11.8% in 2008 to 15.4% in 2017 (figure). Upon adjusting for demographics, comorbid conditions, and hospitalization characteristics, year remained a significant predictor of increasing nephrology follow-up after AKI (per year HR 1.024, 95% CI 1.021-1.027, p<0.01).

Conclusion

From 2008 to 2017, there was a modest increase in post-AKI follow-up that persisted after accounting for changing demographic, comorbid conditions and hospitalization characteristics. However, most patients with severe AKI did not have an outpatient visit with a nephrologist at 6 months, highlighting opportunities to improve processes of post-AKI care.

Funding

  • Other U.S. Government Support