Abstract
BACKGROUND
Few studies have characterized follow-up after pediatric acute kidney injury (AKI). Our aim was to describe outpatient AKI follow-up after pediatric intensive care unit (PICU) admission.
METHODS
Two-center retrospective cohort study (0–18 years; PICU survivors (2003–2005); noncardiac surgery; and no baseline kidney disease). Provincial administrative databases were used to determine outcomes. Exposure: AKI (KDIGO (Kidney Disease: Improving Global Outcomes) definitions). Outcomes: post-discharge nephrology, family physician, pediatrician, and non-nephrology specialist visits. Regression was used to evaluate factors associated with the presence of nephrology follow-up (Cox) and the number of nephrology and family physician or pediatrician visits (Poisson), among AKI survivors.
RESULTS
Of n = 2041, 355 (17%) had any AKI; 64/355 (18%) had nephrology; 198 (56%) had family physician or pediatrician; and 338 (95%) had family physician, pediatrician, or non-nephrology specialist follow-up by 1 year post discharge. Only 44/142 (31%) stage 2–3 AKI patients had nephrology follow-up by 1 year. Inpatient nephrology consult (adjusted hazard ratio (aHR) 7.76 [95% confidence interval (CI) 4.89–12.30]), kidney admission diagnosis (aHR 4.26 [2.21–8.18]), and AKI non-recovery by discharge (aHR 2.65 [1.55–4.55]) were associated with 1-year nephrology follow-up among any AKI survivors.
CONCLUSIONS
Nephrology follow-up after AKI was uncommon, but nearly all AKI survivors had follow-up with non-nephrologist physicians. This suggests that AKI follow-up knowledge translation strategies for non-nephrology providers should be a priority.
Impact
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Pediatric AKI survivors have high long-term rates of chronic kidney disease (CKD) and hypertension, justifying regular kidney health surveillance after AKI.
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However, there is limited pediatric data on follow-up after AKI, including the factors associated with nephrology referral and extent of non-nephrology follow-up.
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We found that only one-fifth of all AKI survivors and one-third of severe AKI (stage 2–3) survivors have nephrology follow-up within 1 year post discharge.
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However, 95% are seen by a family physician, pediatrician, or non-nephrology specialist within 1 year post discharge.
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This suggests that knowledge translation strategies for AKI follow-up should be targeted at non-nephrology healthcare providers.
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Acknowledgements
This work was funded by an operating grant from the Fonds de Recherche du Quebec-Sante. M.Z. was supported by a research salary award from the Fonds de Recherche du Quebec-Sante during the performance of the majority of this work.
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C.R., R.C. and M.Z. conceptualized and designed the study, coordinated and supervised data collection and/or analysis, drafted the initial manuscript, and reviewed and revised the manuscript. J.L., P.J. and V.P. conceptualized and designed the study, coordinated and supervised data collection and analysis, and reviewed and revised the manuscript. E.H. and S.N. conceptualized and designed the study, performed data collection, reviewed data analyses, assisted with data interpretation, and reviewed and revised the manuscript. M.D. reviewed and revised the proposed study design, was primarily responsible for data analysis, and reviewed and revised the manuscript. All authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Robinson, C., Hessey, E., Nunes, S. et al. Acute kidney injury in the pediatric intensive care unit: outpatient follow-up. Pediatr Res 91, 209–217 (2022). https://doi.org/10.1038/s41390-021-01414-9
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DOI: https://doi.org/10.1038/s41390-021-01414-9
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