Kidney Week

Abstract: SA-PO027

Nephrology Follow-Up and Mortality of Critically Ill Patients with AKI

Session Information

• AKI: Clinical, Outcomes, and Trials - Management
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Jeong, Rachel, University of Calgary, Calgary, Alberta, Canada

Rachel Jeong, MD

• Clarke, Alix, University of Calgary, Calgary, Alberta, Canada

Alix Clarke, MSc

• Ravani, Pietro, University of Calgary, Calgary, Alberta, Canada

Pietro Ravani, MD, PhD

• Quinn, Robert R., University of Calgary, Calgary, Alberta, Canada

Robert R. Quinn, MD, PhD

• James, Matthew T., University of Calgary, Calgary, Alberta, Canada

Matthew T. James, MD, PhD

• Bagshaw, Sean M., University of Alberta, Edmonton, Alberta, Canada

Sean M. Bagshaw, MD

• Stelfox, Henry Thomas, University of Alberta, Edmonton, Alberta, Canada

Henry Thomas Stelfox, MD, PhD

• Harrison, Tyrone, University of Calgary, Calgary, Alberta, Canada

Tyrone Harrison, MD, PhD

• Pannu, Neesh I., University of Alberta, Edmonton, Alberta, Canada

Neesh I. Pannu, MD

• Niven, Daniel, University of Calgary, Calgary, Alberta, Canada

Daniel Niven, MD, PhD

• Lam, Ngan, University of Calgary, Calgary, Alberta, Canada

Ngan Lam, MD, MSc

Background

Acute kidney injury (AKI) is common in the intensive care unit (ICU) and associated with adverse outcomes. We sought to estimate the association between nephrology follow-up within 3 months post-discharge and mortality in survivors of critical illness and moderate-to-severe AKI, compared to family physician-only follow-up.

Methods

In this retrospective cohort study in Alberta, Canada, we identified adult patients admitted to ICU with KDIGO stage 2-3 AKI from 2005-2020 who survived to 3 months post-discharge without kidney replacement therapy or eGFR <15 mL/min/1.73 m². Patients with nephrology follow-up were matched 1:1 on their propensity scores for nephrology vs. family physician-only follow-up within 3 months post-discharge. The primary outcome was death from 3 months post-discharge, reported as the cumulative incidence at 12, 24 and 50 months and hazard ratios (HR [95% confidence interval, CI]).

Results

Of 8979 survivors of critical illness and stage 2-3 AKI at 3 months post-discharge, 500 (6%) received nephrology and 7455 (83%) received family physician-only follow-up. Outcome analysis included 437 patient pairs. Risks at 12, 24, and 50 months in patients with nephrology follow-up were 7%, 13%, and 26%, respectively, compared to 14%, 21%, and 36%, in patients with family physician-only follow-up (Figure 1). Nephrology follow-up was associated with lower mortality risk compared to family physician-only follow-up (HR 0.58 [95% CI: 0.44, 0.77] in the first 35 months and 1.09 [95% CI: 0.83, 1.42] after 35 months).

Conclusion

In survivors of critical illness and stage 2-3 AKI, nephrology follow-up was associated with lower mortality, with potential benefits up to 3 years.

Figure 1. Cumulative incidence of death.

Funding

• Private Foundation Support