AKI Linked to Unplanned Readmissions

Acute kidney injury (AKI) is strongly associated with an increased risk of unplanned hospital readmissions—especially for acute pulmonary edema, according to a study in BMC Nephrology.

The researchers analyzed Scottish population-based data on 16,453 patients who were hospitalized and survived to discharge in 2003. Of these, 2623 patients had AKI, based on KDIGO criteria. AKI and other candidate predictors were analyzed as risk factors for unplanned readmission or death within 90 days.

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The main study outcome occurred in 18.6% of patients: readmission in 2701 and death without readmission in 363. On multivariable analysis, AKI was a strong risk factor for the combined outcome: odds ratio 1.50 for stage 1, 2.23 for stage 2, and 2.80 for stage 3. The reason for readmission was acute pulmonary edema in 26.6% of AKI cases, compared to 4.0% of those with no AKI and normal kidney function. Although AKI was a strong predictor, it added little incremental value when added to other predictive models.

Acute kidney injury is a common and serious condition; coordinated care is needed to prevent avoidable complications. The new analysis finds that AKI is a “strong, consistent, and independent risk factor” for unplanned hospital readmissions.

More than one-fourth of readmissions in AKI patients may be related to acute pulmonary edema—a potentially modifiable condition. Some readmissions “may be avoidable by careful pre-emptive planning after AKI to prevent the development of pulmonary edema,” the investigators conclude [Sawhney S, et al. Acute kidney injury as an independent risk factor for unplanned 90-day hospital readmissions. BMC Nephrol 2017; 18: 9 DOI: 10.1186/s12882-016-0430-4].