Abstract: FR-PO084
Primary Care Perspectives (PCPs) on Monitoring and Follow-Up after Hospitalization with AKI
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Kaushal, Saniya, University College Cork School of Medicine, Cork, Ireland
- James, Matthew T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
- Levin, Adeera, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Birks, Peter C., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
Background
AKI is associated with an increased risk of chronic kidney disease (CKD), cardiovascular disease, and mortality. KDIGO guidelines recommend at minimum rechecking creatinine and urine albumin to creatinine ratio (ACR) within 3 months of AKI. Furthermore, nephrology referral after AKI remains low despite an association with improved patient outcomes. The objective of this study was to analyze perspectives of PCPs on monitoring and follow-up of AKI following hospitalization.
Methods
We surveyed Canadian PCPs using clinical vignettes about choices of laboratory monitoring and nephrology referral, following patient hospitalizations with AKI. The vignettes described various demographic and clinical factors, as well as different severities of AKI and degrees of AKI recovery.
Results
53 PCPs participated, completing at least one question. 90% of PCPs would ‘definitely’ or “probably” suggest a follow-up creatinine within 3 months of patient hospitalization with AKI, irrespective of patient variables. Participants were more likely to ‘definitely’ or ‘probably’ suggest follow up creatinine in patients with less recovery of kidney function (98%), for those receiving dialysis (98%), and for those with comorbidities (100%). 80% or more of PCPs would ‘definitely’ or “probably” suggest a follow-up measurement of urine ACR within 3 months of AKI and were more likely to recommend proteinuria monitoring in those with pre-existing CKD (90%). Less than 50% of PCPs would ‘definitely’ refer to a nephrologist following a patient’s AKI, unless they required acute dialysis during hospitalization (54%). Factors associated with increased referrals to nephrology included severe AKI (e.g. stage 3 AKI), less renal recovery, and comorbidities. Less than 25% of PCPs would ‘definitely’ or ‘probably’ seek specialist input prior to restarting a patient's ramipril, metformin, and empagliflozin post-AKI if the creatinine improved to 100 μmol/L.
Conclusion
Most PCPs suggest monitoring their patient’s creatinine within 3 months of hospitalization with AKI. PCPs often would not refer to nephrology for follow up or medication advice after cases of moderate or severe AKI. Education and quality improvement initiatives warrant further testing to help PCPs optimally monitor and manage patients after a hospitalization with AKI.