Abstract: SA-PO028
Nephrology Follow-Up Care Patterns for Survivors of Neonatal Intensive Care Unit 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
- Williams, Anna Elisabeth, Duke University School of Medicine, Durham, North Carolina, United States
- Diamantidis, Clarissa Jonas, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Gbadegesin, Rasheed A., Duke University School of Medicine, Durham, North Carolina, United States
Background
Acute kidney injury (AKI) is the sudden loss of kidney function and complicates nearly 25% of neonatal intensive care unit (NICU) hospitalizations. Neonates who survive AKI events are at increased risk of long term adverse outcomes such as the development of chronic kidney disease, however few guidelines exist to promote nephrology follow-up at discharge for this high-risk group. We investigated patterns of neonatal AKI survivor nephrology follow-up to determine patient- and provider-level factors associated with receipt of AKI follow-up at discharge.
Methods
Retrospective review of 100 neonates at a single academic center NICU with diagnosis of AKI during the first month of life identified via ICD-10 diagnostic codes and confirmed by laboratory findings concordant with KDIGO neonatal AKI diagnosis. Data collected included patient-level characteristics—sex, gestational age, AKI stage, and AKI etiology—and provider-level characteristics—discharging provider type. The primary outcome was outpatient nephrology follow-up care as defined by a scheduled follow-up visit at time of discharge. Data were compared by Fisher’s exact test.
Results
From January 2017-December 2020, 85 neonates with diagnosis of AKI survived to discharge. The population was male predominant (66%) with a median gestational age of 26 weeks. About three quarters (75%) experienced Stage 2 or Stage 3 AKI. Etiology of AKI was predominantly due to nephrotoxic medication exposure such as indomethacin, gentamicin and vancomycin (82%). Inpatient nephrology involvement in NICU care was limited (10%). Most neonates were discharged home by neonatal nurse practitioners (92%). Few neonates (3%) had scheduled nephrology follow-up care recorded at discharge. AKI stage, AKI etiology or receipt of inpatient nephrology consultation did not correlate with receipt of outpatient nephrology follow-up care at discharge.
Conclusion
Post-AKI nephrology follow-up is lacking in survivors of neonatal AKI regardless of AKI severity or etiology. Though not clinically significant, infrequent pediatric nephrology consultation in the hospital likely influenced lack of outpatient nephrology follow-up. This provides opportunity for provider education and collaboration with pediatric nephrologists to unify follow-up practices and mitigate adverse AKI-related outcomes in this population.
Funding
- Private Foundation Support