Nephrologist Care Improves Outcomes after AKI

For patients with an episode of acute kidney injury (AKI), early nephrology follow-up is associated with improved survival 2 years later, according to a report in Kidney International.

Ontario health data were used to identify hospitalized adults receiving temporary inpatient dialysis after an episode of AKI between 1996 and 2008. The analysis included 3877 patients who survived for 90 days after discharge free of dialysis, with follow-up information through 2 years after discharge. Of these, 1583 patients received early follow-up with a nephrologist and could be matched to a patient without a nephrologist. The risk of all-cause mortality was compared on propensity-matched analysis.

All-cause mortality was 8.4 per 100 patient-years for patients with early nephrologist follow-up versus 10.6 per 100 patient-years for those without nephrologist follow-up: hazard ratio 0.76. Within 2 years, 15.5 and 18.9 percent of patients had died, respectively. In subgroup analyses, the survival benefit was significant for men, patients younger than 65 years, those with a history of diabetes, and those with no previous nephrology consultation.

Even if kidney function recovers, patients with AKI remain at increased risk of death. Care after discharge may affect the prognosis; yet, only 8 percent of patients see a nephrologist within 1 year.

The new study suggests improved survival with early nephrologist follow-up of hospitalized patients who survive an episode of AKI. The authors call for further studies to clarify optimal care for AKI survivors, including the role of nephrology care [Harel Z, et al. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury. Kidney Int 2013; 83:901–908].