Practice patterns and predictors of outpatient care following acute kidney injury in an Australian healthcare setting.

Abstract

BACKGROUND:

Survivors of acute kidney injury (AKI) are at increased risk of major adverse kidney events and international guidelines recommend individuals be evaluated 3 months following AKI.

AIM:

We describe practice patterns and predictors of post-AKI care in an Australian tertiary hospital.

METHODS:

A retrospective analysis was undertaken of adults with AKI (defined by KDIGO criteria) admitted to a single centre between 2012 and 2016. The primary outcome was outpatient nephrology review at 3 months. Secondary outcomes included inpatient nephrology review, and outpatient serum creatinine and urinary protein measurements. Data were analysed using multivariable logistic and competing risk regression.

RESULTS:

Only 117 of 2111 (6%) patients with AKI were reviewed by a nephrologist at 3 months. Reviewed patients were more likely to have a higher discharge serum creatinine (odds ratio (OR) 1.20 per 10 μmol/L increase; 95% confidence interval (CI) 1.16-1.25) or a history of peripheral vascular disease (OR 1.77; 95% CI 1.00-3.14). They were less likely to be older (OR 0.66 per decade; 95% CI 0.57-0.76) or to have a history of liver (OR 0.47; 95% CI 0.26-0.87) or ischaemic heart (OR 0.50; 95% CI 0.27-0.94) disease. AKI stage did not predict follow up. The median time from discharge to outpatient serum creatinine testing was 12 days (interquartile range 4-47) and proteinuria was measured in 538 (25%) patients.

CONCLUSIONS:

A minority of admitted AKI patients receive recommended post-AKI care. Studies in other Australian institutions are required to confirm or refute these concerning findings.

• Authors: Emily J See, David G Ransley, Kevan R Polkinghorne, Nigel D Toussaint, Michael Bailey, David W Johnson, Ray Robbins, Rinaldo Bellomo
• Journal: Internal medicine journal (Intern Med J) Vol. 52 Issue 1 Pg. 79-88 (Jan 2022) ISSN: 1445-5994 [Electronic] Australia
• PMID: 33197133 (Publication Type: Journal Article)
• Copyright: © 2020 Royal Australasian College of Physicians.

Topics

• Acute Kidney Injury (diagnosis, epidemiology, therapy)
• Adult
• Ambulatory Care
• Australia (epidemiology)
• Delivery of Health Care
• Humans
• Retrospective Studies