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Abstract: FR-PO060

Follow-Up Care of Critically Ill Patients With AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Jeong, Rachel, Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
  • Clarke, Alix, Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
  • James, Matthew T., Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
  • Quinn, Robert R., Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
  • Ravani, Pietro, Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
  • Bagshaw, Sean M., Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
  • Stelfox, Henry Thomas, Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
  • Pannu, Neesh I., Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
  • Lam, Ngan, Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
Background

Acute kidney injury (AKI) occurs in more than half of critically ill patients in the intensive care unit and is associated with adverse outcomes. The 2012 Kidney Disease Improving Global Outcomes guideline recommends follow-up at 3 months post-discharge for assessment of kidney health. It remains unclear whether these recommendations are followed. Our objective was to determine processes of follow-up care for critically ill patients with AKI.

Methods

We conducted a retrospective cohort study in Alberta, Canada, using linked healthcare databases within the Alberta Kidney Disease Network. We included critically ill adult patients with evidence of AKI (defined as ≥50% or ≥26.5 µmol/L serum creatinine increase from baseline) from 2005-2018. The primary outcome was an outpatient nephrology follow-up visit within 3 months of discharge. Secondary outcomes were an outpatient serum creatinine or urine protein measurement, and a follow-up visit by a family physician within 3 months of discharge.

Results

There were 29,732 critically ill adult patients with AKI. The median age was 68 years, 39% were female, and the median estimated glomerular filtration rate was 72 mL/min/1.73 m2. The cumulative incidence of receiving nephrology follow-up within 3 months before dying or requiring maintenance kidney replacement therapy was 5%. At 3 months, 64% and 28% of patients had an outpatient creatinine and urine protein measurement, respectively, and 89% received follow-up by a family physician. Factors associated with nephrology follow-up were younger age, urban residence, lower baseline estimated glomerular filtration rate, higher baseline albuminuria, previous nephrology visit, shorter hospitalization stay, higher severity of AKI, receipt of acute dialysis, inpatient nephrology consultation, kidney biopsy, and worse kidney function at the time of discharge.

Conclusion

Many critically ill patients with AKI do not receive the recommended follow-up care. Our findings illustrate a significant gap in the transition of care for critically ill patients with AKI. Further research is needed to determine if follow-up care is associated with improved patient outcomes.

Funding

  • Private Foundation Support