An AKI Follow-up Clinic Reduces Mortality—But Not Kidney Events

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For hospitalized patients with acute kidney injury (AKI), nephrologist assessment in an AKI follow-up clinic is associated with a reduced risk of death, although no reduction in major adverse kidney events, reports a study in the American Journal of Kidney Diseases.

The retrospective analysis included 164 patients who survived a hospitalization with AKI and attended an AKI follow-up clinic at one Ontario, Canada, hospital between 2013 and 2017. Clinic visits occurred within 6 months of discharge. All patients had Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 to 3 AKI and were not dialysis dependent at discharge. Approximately two-thirds of patients were men; the mean age was 66 years.

At the AKI follow-up clinic, patients received standardized assessment by a nephrologist, focused on blood pressure and proteinuria reduction, cardiovascular risk reduction, and management of chronic kidney disease (CKD) complications. Patients also received a sick-day medication list and quarterly laboratory tests for 1 year. Each patient attending the follow-up clinic was propensity score matched to four patients receiving standard care. Outcomes of interest were kidney and cardiovascular events, death from any cause, and use of cardioprotective medications.

At a mean follow-up of 2.2 years, the rate of major adverse kidney events was similar between groups: 22.1 per 100 patient-years for patients attending the AKI follow-up clinic and 24.7 per 100 patient-years for those receiving standard care. All-cause mortality was lower in the follow-up clinic group: 7.5 versus 10.7 deaths per 100 patient-years; hazard ratio (HR), 0.71. There was no difference in risk of chronic dialysis or CKD.

Risk of major cardiovascular events was significantly lower among patients seen at the AKI follow-up clinic: 11.0 versus 14.5 events per 100 patient-years; HR, 0.77. Clinic attendance was associated with higher rates of nephrologist visits, creatinine tests, and proteinuria within the first year after AKI. Follow-up clinic patients were more likely to be prescribed important cardioprotective medications, including statins, beta-blockers, and sodium-glucose cotransporter-2 inhibitors, although not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

Although survivors of AKI have increased kidney and cardiovascular risks, they often have limitations in follow-up care. The authors’ experience provides preliminary evidence that nephrologist evaluation at an AKI follow-up clinic has benefits, including decreased mortality and cardiovascular events.

The cohort study shows no reduction in adverse kidney events, however. The researchers conclude, “These results justify further testing of protocolized follow-up after AKI in randomized controlled trials” [Silver SA, et al. Association of an acute kidney injury follow-up clinic with patient outcomes and care processes: A cohort study. Am J Kidney Dis, published online ahead of print November 30, 2022. doi: 10.1053/j.ajkd.2022.10.011;].