Abstract
Leading organisations recommend follow-up of acute kidney injury (AKI) survivors, as these patients are at risk of long-term complications and increased mortality. Information transfer between specialties and from tertiary to primary care is essential to ensure timely and appropriate follow-up. Our aim was to examine the association between completeness of discharge documentation and subsequent follow-up of AKI survivors who received kidney replacement therapy (KRT) in the Intensive Care Unit (ICU). We retrospectively analysed the data of 433 patients who had KRT for AKI during ICU admission in a tertiary care centre in the UK between June 2017 and May 2018 and identified patients who were discharged from hospital alive. Patients with pre-existing end-stage kidney disease and patients who were transferred from hospitals outside the catchment area were excluded. The primary objective was to assess the completeness of discharge documentation from critical care and hospital; secondary objectives were to determine cardiovascular medications reconciliation after AKI, and to investigate kidney care and outcomes at 1 year. The development of AKI and the need for KRT were mentioned in 85 and 82% of critical care discharge letters, respectively. Monitoring of kidney function post-discharge was recommended in 51.6% of critical care and 36.3% of hospital discharge summaries. Among 35 patients who were prescribed renin-angiotensin-aldosterone system inhibitors before hospitalisation, 15 (42.9%) were not re-started before discharge from hospital. At 3 months, creatinine and urine protein were measured in 88.2 and 11.8% of survivors, respectively. The prevalence of chronic kidney disease stage III or worse increased from 27.2% pre-hospitalisation to 54.9% at 1 year (p < 0.001). Our data demonstrate that discharge summaries of patients with AKI who received KRT lacked essential information. Furthermore, even in patients with appropriate documentation, renal follow-up was poor suggesting the need for more education and streamlined care pathways.
Highlights
Acute kidney injury (AKI) is common in the Intensive Care Unit (ICU) affecting more than 50% of critically ill patients [1, 2]
Between June 2017 and May 2018, 2,380 patients were admitted to the critical care unit of whom 433 (18.2%) critically ill patients received continuous kidney replacement therapy (CKRT) and/or prolonged intermittent kidney replacement therapy (PIKRT) (Supplementary Figure 1)
We excluded patients with end-stage kidney disease (ESKD) (n = 96) or a renal transplant (n = 22), patients transferred from an ICU in another catchment area (n = 72) and patients who died during hospitalisation (n = 164)
Summary
Acute kidney injury (AKI) is common in the Intensive Care Unit (ICU) affecting more than 50% of critically ill patients [1, 2]. The development of AKI is associated with serious complications, increased mortality and high health care costs [4,5,6]. About 1 in 6 patients with severe AKI become dialysis dependent in the following 2–3 years [8]. There is increasing recognition that an episode of AKI is associated with a deterioration of other chronic illnesses, either directly or as a result of changes to medications [7]. Leading organisations, including the National Institute for Health and Care Excellence (NICE), the Renal Association and the Royal College of General Practitioners (RCGP) recommend nephrology follow-up after an episode of severe AKI, actual follow-up rates range from 8.5 to 41% [3, 9,10,11,12]. Delayed or inadequate follow-up care has been shown to contribute to worse outcomes [12]
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