Nephrology follow-up and all-cause mortality of severe acute kidney injury survivors

Abstract

To the Editor: We have read with interest the article by Harel et al.,1 in which they examined retrospectively the impact of early nephrology follow-up (within 90 days of discharge) on mortality in survivors (within a maximum follow-up of 2 years) of dialysis requiring acute kidney injury (AKI) using a propensity score–based matching of patients with and without nephrology follow-up on over 40 demographic and clinical variables. They found that the incidence of all-cause mortality was lower in those patients with early nephrology follow-up compared with those without (8.4 compared with 10.6 per 100 patient-years, hazard ratio 0.76 (95% confidence interval 0.62–0.93)). This observation strongly argues the value of the specialist follow-up after hospitalization in survivors of severe AKI as it has been shown in other severe acute conditions (i.e., myocardial infarction, heart failure, and chronic obstructive pulmonary disease).2, 3, 4 Besides the limitations pointed out in the article, the authors have not evaluated the number of patients admitted to intensive care unit (ICU) and have not mentioned the causes of death. We should remember that AKI in the ICU should be distinguished from AKI in other clinical settings, as the underlying pathophysiology, severity of illness, and risk for permanent sequelae may be different. Furthermore, the identification of causes of death among AKI survivors followed up and not followed up by nephrologists could contribute to clarify the optimal care for AKI survivors and the role played by nephrologists.