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Kidney Week

Abstract: PO0007

Adequacy of Kidney Follow-Up Among AKI Survivors After Hospital Discharge

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Barreto, Erin F., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Schreier, Diana J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • May, Heather P., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Mara, Kristin C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Chamberlain, Alanna, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Wi, Chung-Il, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Acute kidney injury (AKI) affects 20% of hospitalized patients and results in long-term adverse outcomes. To limit its complications, post-discharge follow-up is advised. The objective of the study was to evaluate the frequency of appropriate follow-up after discharge among AKI survivors.

Methods

This was a population-based cohort study of adult Olmsted County residents hospitalized at their local hospital (Mayo Clinic in Rochester, MN) with an episode of stage II or III AKI between 2006 and 2014. Those dismissed from the hospital on dialysis or who died within 30-days after discharge were excluded. The cumulative incidence of adequate kidney follow-up defined by a serum creatinine (SCr) level and/or an in-person healthcare visit within 30-days, 90-days, or 1-year after discharge was described.

Results

There were 563 survivors of AKI studied [Stage II: N=360 (64%); Stage III: N=203 (36%)]. The 30-day cumulative incidence of follow-up with SCr was 78% (95% confidence interval (CI) : 74%, 81%), by provider visit was 80% (95% CI: 77%, 83%), by both SCr assessment and provider visit was 70% (95% CI: 65%, 73%). Within 90-days and 1-year, the cumulative incidences of both SCr assessment and provider visit rose to 81% and 91%, respectively. Within 30-days after discharge, only 13% (95% CI: 10%, 16%) of these stage II or III AKI survivors saw a nephrologist. The statistically significant predictors of receiving both a SCr assessment and provider visit within 30-days included higher body mass index, worse baseline and discharge kidney function, higher comorbidity burden, greater maximum AKI severity, and longer duration of AKI during the hospitalization. Age, sex, race/ethnicity, education status, and socioeconomic status did not predict kidney follow-up.

Conclusion

These data demonstrated that 30% of patients with moderate to severe AKI received insufficient kidney follow-up in the 30-day post-discharge interval. Medical risk factors rather than social/demographic characteristics were the primary determinants of kidney follow-up.

Funding

  • Other NIH Support