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RATIONALE & OBJECTIVE: Since January 2017, patients with acute kidney injury requiring dialysis (AKI-D) can be discharged to outpatient dialysis centers for continued hemodialysis (HD) support. We aimed to examine the rate of kidney recovery, time to recovery, and hospitalization-related clinical parameters associated with kidney recovery in patients with AKI-D. STUDY DESIGN: Single-center prospective cohort study. SETTING & PARTICIPANTS: 111 adult patients who were admitted to the University of Kentucky Hospital, experienced AKI-D, and were discharged with need of outpatient HD. EXPOSURE: Hospitalization-related clinical parameters were evaluated. OUTCOME: Kidney recovery as a composite of being alive and no longer requiring HD or other form of kidney replacement therapy. ANALYTICAL APPROACH: Discrete-time survival analysis and logistic regression were used to determine adjusted probabilities of kidney recovery at prespecified time points and to evaluate clinical parameters associated with recovery. RESULTS: 45 (41%) patients recovered kidney function, 25 (55.5%) within the first 30 days following discharge, 16 (35.5%) within 30 to 60 days, and 4 (9%) within 60 to 90 days. Adjusted probabilities of recovery were 36.7%, 27.4%, and 6.3%, respectively. Of the remaining patients, 49 (44%) developed kidney failure requiring chronic kidney replacement therapy and 17 (15%) died or went to hospice. Patients who did not recover kidney function were older, had more comorbid conditions, had lower estimated glomerular filtration rates at baseline, and received more blood transfusions during hospitalization when compared with those who recovered kidney function. LIMITATIONS: Selection bias given that patients included in the study were all eligible for AKI management with outpatient HD as part of Medicare/Medicaid services. CONCLUSIONS: At least one-third of AKI-D survivors discharged from an acute care hospital dependent on HD recovered kidney function within the first 90 days of discharge, more commonly in the first 30 days postdischarge. Future studies should elucidate clinical parameters that can inform risk classification and interventions to promote kidney recovery in this vulnerable and growing population.
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BACKGROUND: Survivors of acute kidney injury (AKI) are at risk of adverse outcomes. Post-discharge nephrology care may improve patients' AKI knowledge and prevent post-AKI complications. OBJECTIVE: The purpose of this study was to examine patients' awareness about their AKI diagnosis and self-rated knowledge and severity of AKI before and after their first post-discharge AKI Clinic encounter. DESIGN: We conducted a pre- and post-survey study among AKI survivors who attended a post-discharge AKI Clinic. SETTING: AKI Clinic at the University of Kentucky Medical Center (October 2016 to December 2017). Education about AKI was based on transformative learning theory and provided through printed materials and interdisciplinary interactions between patients/caregivers and nurses, pharmacists, and nephrologists. PATIENTS: A total of 104 patients completed the survey and were included in the analysis. MEASUREMENTS: Three survey questions were administered before and after the first AKI Clinic encounter: Question 1 (yes-no) for awareness, and questions 2 and 3 (Likert scale, 1 = lowest to 5 = highest) for self-rated knowledge and severity of AKI. METHODS: Two mixed-model analysis of variance (ANOVA) was used for between-group (AKI severity) and within-group (pre- and post-encounter) comparisons. Logistic regression was used to examine parameters associated with the within-group change in self-perceived knowledge. RESULTS: Twenty-two out of 104 (21%) patients were not aware of their AKI diagnosis before the clinic encounter. Patients' self-ratings of their AKI knowledge significantly increased after the first AKI Clinic encounter (mean ± SEM: pre-visit = 1.94 ± 0.12 to post-visit = 3.88 ± 0.09, P = .001), even after adjustment for age, gender, Kidney Disease Improving Global Outcomes (KDIGO) severity stage, or poverty level. Patients with AKI stage 3 self-rated their AKI as more severe than patients with AKI stage 1 or 2. LIMITATIONS: Our study population may not be representative of the general AKI survivor population. Administered surveys are subject to response-shift bias. CONCLUSIONS: Patients' self-perceived knowledge about AKI significantly increased following the first post-discharge AKI Clinic encounter that included interdisciplinary education. This is the first survey study examining self-perceived AKI knowledge in AKI survivors. Further examination of AKI literacy in survivors of AKI and its effect on post-AKI outcomes is needed. TRIAL REGISTRATION: Not applicable.
CONTEXTE: Les survivants d'un épisode d'insuffisance rénale aiguë (IRA) risquent de souffrir de pathologies associées. Un suivi en néphrologie après la sortie de l'hôpital pourrait accroître les connaissances des patients sur la maladie et prévenir les complications. OBJECTIF: L'étude était bipartite : i) savoir si les patients connaissaient leur diagnostic; ii) mesurer, par auto-évaluation, les connaissances des patients sur l'IRA et sur sa gravité, avant et après une consultation dans une clinique d'IRA. TYPE D'ÉTUDE: Un sondage mené auprès de survivants d'un épisode d'IRA, avant et après une consultation en clinique d'IRA suivant leur congé de l'hôpital. CADRE: La clinique d'IRA du centre médical de l'université du Kentucky (d'octobre 2016 à décembre 2017). L'information fournie suivait la théorie de l'apprentissage transformationnel et était transmise sous forme de documents imprimés et d'interactions interdisciplinaires entre les patients/fournisseurs de soins et les infirmières, les pharmaciens et les néphrologues. PARTICIPANTS: L'étude porte sur 104 patients ayant complété le sondage. MESURES: Trois questions ont été posées aux patients avant et après une première consultation à la clinique. Une question portait sur leur connaissance du diagnostic (oui -non) et deux autres auto-évaluaient leurs connaissances sur l'IRA et sa gravité (échelle de Likert, de 1 [plus faible] à 5 [plus élevé]). MÉTHODOLOGIE: Deux modèles mixtes d'analyse de variance ont été employés pour établir des comparaisons inter-groupes (gravité de l'IRA) et intra-groupes (pré et post-consultation). Une régression logistique a été utilisée pour analyser les paramètres associés aux changements du niveau auto-évalué des connaissances dans un même groupe. RÉSULTATS: Des 104 patients inclus à l'étude, 22 (21 %) ignoraient leur diagnostic d'IRA avant la consultation. L'auto-évaluation des connaissances a augmenté après la première consultation (moyenne ± SEM : 1,94 ± 0,12 [pré-visite]; 3,88 ± 0,09 [post-visite], p=0,001) et ce, même après les ajustements en regard de l'âge et du sexe du patient, du stade de la maladie selon le KDIGO (Kidney Disease Improving Global Outcomes) ou du niveau de revenus. Les patients atteints d'une IRA de stade 3 ont davantage surévalué la gravité de leur maladie que les patients de stades 1 ou 2. LIMITES: La population étudiée pourrait ne pas être représentative de la population générale des survivants d'un épisode d'IRA. Les sondages sont sujets aux biais liés aux changements de réponses. CONCLUSION: L'auto-évaluation des connaissances a augmenté significativement après une première consultation à la clinique d'IRA lorsque celle-ci incluait de l'information interdisciplinaire. Il s'agit de la première étude portant sur l'auto-évaluation des connaissances de survivants d'un épisode d'IRA. Il est nécessaire d'examiner davantage la littératie de l'IRA chez les survivants de la maladie et ses effets sur les pathologies qui en découlent.
