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Abstract: PO0230

Association of an AKI Follow-Up Clinic with Patient Outcomes and Care Processes: A Propensity-Matched Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
  • Adhikari, Neill, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • Jeyakumar, Nivethika, Western University, London, Ontario, Canada
  • Harel, Ziv, University of Toronto, Toronto, Ontario, Canada
  • Dixon, Stephanie, Western University, London, Ontario, Canada
  • Luo, Bin, Western University, London, Ontario, Canada
  • Clark, Edward George, Ottawa Hospital, Ottawa, Ontario, Canada
  • Neyra, Javier A., University of Kentucky, Lexington, Kentucky, United States
  • Bell, Chaim, University of Toronto, Toronto, Ontario, Canada
  • Wald, Ron, University of Toronto, Toronto, Ontario, Canada
Background

Survivors of AKI are at higher risk of chronic kidney disease and death, but few patients see a nephrologist following hospital discharge. Our objectives were to determine whether an AKI Follow-up Clinic is associated with changes in care processes and a reduction in major adverse kidney events in comparison to survivors of AKI who received usual care.

Methods

We identified all patients ≥ 18 years of age who survived a hospitalization with AKI from February 1, 2013 to September 30, 2017 and visited our hospital's AKI Follow-up Clinic within 6-months of hospital discharge. We used propensity scores to match each patient to 4 patients in the region who received usual care. We randomly assigned the control group index dates to ensure these patients were alive and could have received follow-up care. The primary outcome was time to a major adverse kidney event, defined as death, chronic dialysis, or CKD (newly sustained eGFR < 60mL/min/1.73m2 or a sustained decrease in eGFR ≥ 25% from baseline). We also measured processes of care after AKI, which included nephrologist visits and serum creatinine/proteinuria testing.

Results

We matched 170 AKI Follow-up Clinic patients to 680 patients who received usual care. Approximately 75% in each group had KDIGO stage 2-3 AKI, with similar mean eGFR [SD] at baseline (64.6 [25.1] versus 64.2 [27] mL/min/1.73m2) and hospital discharge (49.6 [24.6] versus 49.0 [28.1] mL/min/1.73m2). The AKI Follow-up Clinic group had more nephrology visits per patient-year (1.4 [3.1] versus 0.7 [1.5]), with a greater proportion completing serum creatinine (94% versus 84%) and proteinuria (49% versus 25%) tests within 90-days of hospital discharge. Care in the AKI Follow-up Clinic was not associated with time to a major adverse kidney event (HR=0.90, 95% CI 0.72-1.13), but it was associated with a decreased risk of death (HR=0.55, 95% CI 0.37-0.82).

Conclusion

The AKI Follow-up Clinic was not associated with a decreased risk of major adverse kidney events, possibly due to an increased risk of CKD from more serum creatinine testing. The association with reduced mortality warrants confirmation in randomized controlled trials.

Funding

  • Government Support – Non-U.S.