Comprehensive Acute Kidney Injury Rehab May Improve Post-Discharge Outcomes

What is it about?

Acute Kidney Injury (failure), called AKI, in hospitalized patients has devastating consequences. How to improve outcomes in this condition is largely unknown, although small studies have indicated that early nephrology follow-up and improved patient education may help. However, a randomized trial attempting this could only enroll 26% of eligible patients and only 18% actually came for follow-up. We designed an AKI rehabilitation program to overcome barriers to enrollment. This had several components: a real-time electronic-health-record diagnostic algorithm, pre-discharge education, case management support,and nephrology follow-up within 1-3 weeks of hospital discharge. By innovations like improved care coordination, symptom assessment, addressing socioeconomic barriers, and flexible scheduling, we were able to enroll 68% of eligible patients into the program and all of them showed up for follow-up (compared to 18% in prior studies). After statistical adjustment, the risk of dying or getting re-hospitalized within 30 days appeared to be lower in participants of the program, with similar trends in 90-day outcomes. Given that this is a single center, non-randomized study, these findings need careful study before generalizing. However, these initial results are encouraging and should guide future design of larger studies into improving the outcomes for these extremely high-risk patients.

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Photo by Robina Weermeijer on Unsplash

Photo by Robina Weermeijer on Unsplash

Why is it important?

One of the first studies to show an improvement in AKI outcomes using intensive nephrology follow-up

Perspectives