Abstract: FR-PO0424
TRACK-AKI: Quality and Predictors of Guideline-Concordant Transitions of Care After AKI
Session Information
- AKI: Biomarkers, Diagnostics, and Risk Prediction
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Aguilar, Fatima, Montefiore Einstein Medical Center, Bronx, New York, United States
- Cabral Fleischman B C Cunha, Deborah, Montefiore Einstein Medical Center, Bronx, New York, United States
- Johns, Tanya S., Montefiore Einstein Medical Center, Bronx, New York, United States
- Fisher, Molly, Montefiore Einstein Medical Center, Bronx, New York, United States
Background
Acute kidney injury (AKI) survivors are at high risk of recurrent AKI, progressive kidney disease, cardiovascular events, and death. Structured post-discharge care, including nephrology follow-up, kidney function and albuminuria assessment, and resumption of guideline-directed medical therapy (GDMT),such as renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), is associated with improved outcomes. However, post-AKI transition quality and predictors of guideline-concordant care remain poorly characterized.
Methods
We conducted an observational study of AKI survivors discharged from two large urban academic hospitals between September and November 2025. We defined four guideline-concordant transition-of-care elements adapted from the Acute Disease Quality Initiative KAMPS bundle (kidney function, advocacy, medications, pressure, sick day protocols) within 90 days of discharge: 1) nephrology visit, 2) eGFR measurement, 3) albuminuria testing, and 4) clinically indicated GDMT. Multivariable ordinal logistic regression identified predictors of transition elements completed (0-4).
Results
Among 202 AKI survivors (mean age 64±15 yrs; 43% women; 82% Black or Hispanic; 65% KDIGO stage 2 or 3), only 5% completed all elements and 16% completed three. Albuminuria testing and nephrology follow-up were least common (16.8% and 20.8%). Patients seen by a nephrologist were far more likely to complete the other three elements (73.8% vs. 1.2%; p<0.001). Of those with indicated GDMT, 65% were not on RAASi and 69% were not on SGLT2i at 90 days; fewer than 25% had discharge-held GDMT resumed within 90 days. Older age (aOR 0.75 per 10 years [95% CI: 0.63-0.90]) and diabetes (aOR 0.42 [95% CI: 0.25-0.71]) were independently associated with fewer completed elements, while a documented nephrology appointment at discharge was associated with more (aOR 4.46 [95% CI: 2.28-8.72]). Patients with documented appointment were 4 times more likely to be seen by nephrology within 90 days (53.7% vs. 12.4%; p<0.001).
Conclusion
High-quality transitions after AKI are uncommon, and GDMT is frequently not resumed despite clear indications. A nephrology appointment on the discharge summary was the strongest modifiable predictor of higher-quality transitions. Discharge-level interventions targeting referral processes and GDMT resumption represent opportunities to improve post-AKI care.