October 20, 2017 / 5:55 PM / 3 years ago

Follow-up care for acute kidney injury may be lacking

(Reuters Health) - Kidney specialists recommend follow-up care for most patients who have experienced acute kidney injury, but only a minority of patients have been getting that care, according to a Canadian study.

“Acute kidney injury refers to a sudden loss of kidney function that usually develops over the course of days in patients who are hospitalized for a wide variety of conditions,” senior author Dr. Matthew James told Reuters Health by email.

“Kidney problems can resolve after an acute kidney injury; however, some - but not all - patients can develop long-term complications, which include high blood pressure, chronic kidney disease, and cardiovascular events,” said James, a researcher at the Cumming School of Medicine at the University of Calgary.

It’s estimated that 500 of every 100,000 adults in North America, or around 1.4 million people, are hospitalized with acute kidney disease each year, James and his colleagues write in the Clinical Journal of the American Society of Nephrology.

There are many possible causes of kidney injury, including low blood pressure, heart failure or failure of other organs, overuse of NSAID painkillers, burns, major surgery and severe allergic reactions, according to the U.S. National Kidney Foundation.

James and colleagues surveyed 145 Canadian kidney specialists, or nephrologists, presenting them with a variety of acute kidney injury scenarios and asking whether the expert would recommend follow-up care for each patient and what factors would influence that decision.

The researchers then looked at how many patients hospitalized with acute kidney injury in the province of Alberta between 2005 and 2014 actually did have follow-up care from a nephrologist.

The study team found that nephrologists indicated they would definitely or probably re-evaluate patients in 87 percent of the scenarios provided by the researchers.

The doctors were more likely to recommend follow-up for patients with a history of pre-existing chronic kidney disease, heart failure, a need for acute dialysis or a less complete recovery of kidney function.

But, the researchers discovered, only 24 percent of actual patients were seen by a nephrologist in Alberta within one year of being hospitalized with acute kidney injury.

About 20 percent of patients over age 80 and about 43 percent of patients with chronic kidney disease received follow-up care. Almost 80 percent of patients who had consulted with a nephrologist before their hospital stay and about 41 percent who saw nephrologists while in the hospital had follow-ups during the first year, the researchers found.

There is a substantial disparity between the opinions of nephrologists and actual processes of care for nephrology evaluation of patients after hospitalization with acute kidney, James said.

“However, nearly all patients who did not receive nephrology follow-up were seen by at least one other physician within a year of discharge, suggesting there are other opportunities for physicians to follow-up and improve care for patients that have had acute kidney injury,” he told Reuters Health.

Medicare data show similarly low rates of nephrology referral after hospitalization for dialysis-requiring acute kidney disease in the U.S., noted Dr. Joseph A. Vassalotti, chief medical officer of the National Kidney Foundation, who wasn’t involved in the study.

“If you compare what I could call a ‘kidney attack’ or (Acute Kidney Injury) requiring dialysis to a heart attack or a myocardial infarction the care is very different,” Vassalotti said.

Most heart attack patients receive care in Coronary Care Units, or specialized ICUs or other coronary units devoted to the care of patients with heart disease. Cardiologists are nearly always involved and patients are highly likely to see a cardiologist after discharge, Vassalotti said.

“In contrast, what I am calling a kidney attack has a variety of causes and may be cared for anywhere in the hospital (ICU, medical floor, surgical floor, obstetrics, etc),” he said in an email.

In-hospital acute kidney injury is a condition in which checklists or other forms of protocols can improve the consistency and quality of care, Vassalotti added.

It’s important for people with chronic kidney disease to know that it’s the most important risk for acute kidney injury and people with the condition should work with their primary doctor or nephrologist on how to prevent acute kidney injury, he said.

SOURCE: bit.ly/2yrwiNC Clinical Journal of the American Society of Nephrology, online October 12, 2017.

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