Am J Kidney Dis. 2023 Sep 19:S0272-6386(23)00807-7. doi: 10.1053/j.ajkd.2023.07.015. Online ahead of print.
ABSTRACT
RATIONALE & OBJECTIVE: Survivors of acute kidney injury (AKI) are at high risk of adverse outcomes. Monitoring of kidney function, screening for proteinuria, use of statins and renin-angiotensin-aldosterone system inhibitors (RAASi), and nephrology follow-up among survivors have not been fully characterized. We sought to examine these processes of care after discharge in survivors of hospitalized AKI.
DESIGN: Population-based retrospective cohort study.
SETTING AND PARTICIPANTS: Adults in Alberta, Canada admitted to hospital between 2009 and 2017. Study participants were followed from their discharge date until 2019, with a median follow up of 2.7 years.
EXPOSURE: Hospital-acquired AKI diagnostically conforming to Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria for stage 2 or stage 3 disease, or the need for acute dialysis.
OUTCOMES: Outcomes following hospital discharge included the proportion of participants who had evaluation of kidney function, were seen by a specialist or general practitioner, and received prescriptions for recommended medications for chronic kidney disease (CKD) post-discharge.
ANALYTICAL APPROACH: Cumulative incidence curves were used to characterize the proportion of participants who received each process of care outcome within the first 90 days and subsequent 1-year follow-up period after hospital discharge. To avoid risks associated with multiple hypothesis testing, differences were not statistically compared across groups.
RESULTS: The cohort (n = 23,921) included 50.2% men (n = 12,015) with a median [IQR] age of 68.1 years [56.9, 78.8]. Within 90 days post-discharge, 21.2% and 8.6% of patients with and without pre-existing CKD, respectively, were seen by a nephrologist. 60.1% of AKI survivors had at least one serum creatinine measured but only 25.5% had an assessment for albuminuria within 90 days after discharge. 52.7% of AKI survivors with pre-existing CKD, and 51.6% with de novo CKD were prescribed a RAASi within 4-15 months after discharge from hospital.
LIMITATIONS: Retrospective data were collected as part of routine clinical care.
CONCLUSION: The proportion of patients receiving optimal care after an episode of AKI in Alberta was low and may represent a target for improving long-term outcomes for this population.
PMID:37734688 | DOI:10.1053/j.ajkd.2023.07.015
