Post-Discharge Mortality and Rehospitalization among Participants in a Comprehensive Acute Kidney Injury Rehabilitation Program.
acute kidney injury
acute kidney injury and ICU nephrology
acute renal failure
aftercare
economic impact
epidemiology and outcomes
hospitalization
mortality
mortality risk
renal failure
survival
Journal
Kidney360
ISSN: 2641-7650
Titre abrégé: Kidney360
Pays: United States
ID NLM: 101766381
Informations de publication
Date de publication:
30 09 2021
30 09 2021
Historique:
received:
02
06
2021
accepted:
13
07
2021
entrez:
4
4
2022
pubmed:
5
4
2022
medline:
8
4
2022
Statut:
epublish
Résumé
Hospitalization-associated AKI is common and is associated with markedly increased mortality and morbidity. This prospective cohort study examined the feasibility and association of an AKI rehabilitation program with postdischarge outcomes. Adult patients hospitalized from September 1, 2019 to February 29, 2020 in a large health system in Pennsylvania with stage 2-3 AKI who were alive and not on dialysis or hospice at discharge were evaluated for enrollment. The intervention included patient education, case manager services, and expedited nephrology appointments starting within 1-3 weeks of discharge. We examined the association between AKI rehabilitation program participation and risks of rehospitalization or mortality in logistic regression analyses adjusting for comorbidities, discharge disposition, and sociodemographic and kidney parameters. Sensitivity analysis was performed using propensity score matching. Among the high-risk patients with AKI who were evaluated, 77 of 183 were suitable for inclusion. Out of these, 52 (68%) patients were enrolled and compared with 400 contemporary, nonparticipant survivors of stage 2/3 AKI. Crude postdischarge rates of rehospitalization or death were lower for participants versus nonparticipants at 30 days (15% versus 34%; The AKI rehabilitation program was feasible and potentially associated with improved 30-day rehospitalization or mortality. Our interventions present a roadmap to improve enrollment in future randomized trials.
Sections du résumé
Background
Hospitalization-associated AKI is common and is associated with markedly increased mortality and morbidity. This prospective cohort study examined the feasibility and association of an AKI rehabilitation program with postdischarge outcomes.
Methods
Adult patients hospitalized from September 1, 2019 to February 29, 2020 in a large health system in Pennsylvania with stage 2-3 AKI who were alive and not on dialysis or hospice at discharge were evaluated for enrollment. The intervention included patient education, case manager services, and expedited nephrology appointments starting within 1-3 weeks of discharge. We examined the association between AKI rehabilitation program participation and risks of rehospitalization or mortality in logistic regression analyses adjusting for comorbidities, discharge disposition, and sociodemographic and kidney parameters. Sensitivity analysis was performed using propensity score matching.
Results
Among the high-risk patients with AKI who were evaluated, 77 of 183 were suitable for inclusion. Out of these, 52 (68%) patients were enrolled and compared with 400 contemporary, nonparticipant survivors of stage 2/3 AKI. Crude postdischarge rates of rehospitalization or death were lower for participants versus nonparticipants at 30 days (15% versus 34%;
Conclusions
The AKI rehabilitation program was feasible and potentially associated with improved 30-day rehospitalization or mortality. Our interventions present a roadmap to improve enrollment in future randomized trials.
Identifiants
pubmed: 35373103
doi: 10.34067/KID.0003672021
pii: 02200512-202109000-00008
pmc: PMC8786140
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1424-1433Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
Déclaration de conflit d'intérêts
A.R. Chang reports receiving grant support from the National Kidney Foundation (NKF) via the NKF Patient Network; having consultancy agreements with Novartis (as consultant); receiving research funding from Novo Nordisk (investigator-sponsored study); receiving honoraria from Reata; and serving as a scientific advisor for, or member of, Reata and Relypsa. K. Ho reports having other interests in/relationships with the American Society of Nephrology and NKF, and having patents and inventions with Partners Healthcare. H.L. Kirchner reports having consultancy agreements: with Baylor College of Medicine and Guthrie Research Foundation. All remaining authors have nothing to disclose.
Références
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16: 3365–3370, 2005 https://doi.org/10.1681/ASN.2004090740
doi: 10.1681/ASN.2004090740
Silver SA, Harel Z, McArthur E, Nash DM, Acedillo R, Kitchlu A, Garg AX, Chertow GM, Bell CM, Wald R: 30-day readmissions after an acute kidney injury hospitalization. Am J Med 130: 163–172.e4, 2017 https://doi.org/10.1016/j.amjmed.2016.09.016
doi: 10.1016/j.amjmed.2016.09.016
Siew ED, Parr SK, Wild MG, Levea SL, Mehta KG, Umeukeje EM, Silver SA, Ikizler TA, Cavanaugh KL: Kidney disease awareness and knowledge among survivors ofacute kidney injury. Am J Nephrol 49: 449–459, 2019 https://doi.org/10.1159/000499862
doi: 10.1159/000499862
Siew ED, Peterson JF, Eden SK, Hung AM, Speroff T, Ikizler TA, Matheny ME: Outpatient nephrology referral rates after acute kidney injury. J Am Soc Nephrol 23: 305–312, 2012 https://doi.org/10.1681/ASN.2011030315
doi: 10.1681/ASN.2011030315
Hines A, Li X, Ortiz-Soriano V, Saleh S, Litteral J, Ruiz-Conejo M, Wald R, Silver SA, Neyra JA: Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and acute kidney disease after an episode of AKI: A multicenter prospective cohort study. Am J Nephrol 51: 266–275, 2020 https://doi.org/10.1159/000505893
doi: 10.1159/000505893
Qiao Y, Shin JI, Sang Y, Inker LA, Secora A, Luo S, Coresh J, Alexander GC, Jackson JW, Chang AR, Grams ME: Discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease. Mayo Clin Proc 94: 2220–2229, 2019 https://doi.org/10.1016/j.mayocp.2019.05.031
doi: 10.1016/j.mayocp.2019.05.031
Siew ED, Liu KD, Bonn J, Chinchilli V, Dember LM, Girard TD, Greene T, Hernandez AF, Ikizler TA, James MT, Kampschroer K, Kopp JB, Levy M, Palevsky PM, Pannu N, Parikh CR, Rocco MV, Silver SA, Thiessen-Philbrook H, Wald R, Xie Y, Kimmel PL, Star RA: Improving care for patients after hospitalization with AKI. J Am Soc Nephrol 31: 2237–2241, 2020 https://doi.org/10.1681/ASN.2020040397
doi: 10.1681/ASN.2020040397
Harel Z, Wald R, Bargman JM, Mamdani M, Etchells E, Garg AX, Ray JG, Luo J, Li P, Quinn RR, Forster A, Perl J, Bell CM: Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int 83: 901–908, 2013 https://doi.org/10.1038/ki.2012.451
doi: 10.1038/ki.2012.451
Coleman EA, Parry C, Chalmers S, Min SJ: The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med 166: 1822–1828, 2006 https://doi.org/10.1001/archinte.166.17.1822
doi: 10.1001/archinte.166.17.1822
Clancy CM: Reengineering hospital discharge: A protocol to improve patient safety, reduce costs, and boost patient satisfaction. Am J Med Qual 24: 344–346, 2009 https://doi.org/10.1177/1062860609338131
doi: 10.1177/1062860609338131
Berkowitz RE, Fang Z, Helfand BKI, Jones RN, Schreiber R, Paasche-Orlow MK: Project ReEngineered Discharge (RED) lowers hospital readmissions of patients discharged from a skilled nursing facility. J Am Med Dir Assoc 14: 736–740, 2013 https://doi.org/10.1016/j.jamda.2013.03.004
doi: 10.1016/j.jamda.2013.03.004
Kellum JA, Lameire N; KDIGO AKI Guideline Work Group: Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Crit Care 17: 204, 2013 https://doi.org/10.1186/cc11454
doi: 10.1186/cc11454
Siew ED, Matheny ME: Choice of reference serum creatinine in defining acute kidney injury. Nephron 131: 107–112, 2015 https://doi.org/10.1159/000439144
doi: 10.1159/000439144
Jennings KS, Marks S, Lum HD: The surprise question as a prognostic tool #360. J Palliat Med 21: 1529–1530, 2018 https://doi.org/10.1089/jpm.2018.0348
doi: 10.1089/jpm.2018.0348
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L: A reengineered hospital discharge program to decrease rehospitalization: A randomized trial. Ann Intern Med 150: 178–187, 2009 https://doi.org/10.7326/0003-4819-150-3-200902030-00007
doi: 10.7326/0003-4819-150-3-200902030-00007
Bailey MK, Weiss AJ, Barrett ML, Jiang HJ: Characteristics of 30-Day All-Cause Hospital Readmissions, 2010–2016: Statistical Brief #248. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, Rockville, MD, Agency for Healthcare Research and Quality (US), 2006
Horkan CM, Purtle SW, Mendu ML, Moromizato T, Gibbons FK, Christopher KB: The association of acute kidney injury in the critically ill and postdischarge outcomes: A cohort study*. Crit Care Med 43: 354–364, 2015 https://doi.org/10.1097/CCM.0000000000000706
doi: 10.1097/CCM.0000000000000706
Thakar CV, Parikh PJ, Liu Y: Acute kidney injury (AKI) and risk of readmissions in patients with heart failure. Am J Cardiol 109: 1482–1486, 2012 https://doi.org/10.1016/j.amjcard.2012.01.362
doi: 10.1016/j.amjcard.2012.01.362
Iwagami M, Moriya H, Doi K, Yasunaga H, Isshiki R, Sato I, Mochida Y, Ishioka K, Ohtake T, Hidaka S, Noiri E, Kobayashi S: Seasonality of acute kidney injury incidence and mortality among hospitalized patients. Nephrol Dial Transplant 33: 1354–1362, 2018 https://doi.org/10.1093/ndt/gfy011
doi: 10.1093/ndt/gfy011
Wiersema R, Eck RJ, Haapio M, Koeze J, Poukkanen M, Keus F, van der Horst ICC, Pettilä V, Vaara ST: Burden of acute kidney injury and 90-day mortality in critically ill patients. BMC Nephrol 21: 1, 2019 https://doi.org/10.1186/s12882-019-1645-y
doi: 10.1186/s12882-019-1645-y
Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, Himmelfarb J, Collins AJ: Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol 17: 1135–1142, 2006 https://doi.org/10.1681/ASN.2005060668
doi: 10.1681/ASN.2005060668
US Department of Health and Human Services: Caring for outpatients after acute kidney injury (COPE-AKI). Grants & Funding. https://grants.nih.gov/grants/guide/rfa-files/rfa-dk-20-012.html . Accessed December, 2020
Silver S, Adhikari N, Bell C, Chan C, Harel Z, Kitchlu A, Meraz Muñoz A, Norman P, Perez A, Zahirieh A, Wald R: Nephrologist follow-up versus usual care after an acute kidney injury hospitalization (FUSION) [published online ahead of print May 21, 2021]. Clin J Am Soc Nephrol 10.2215/CJN.17331120
doi: 10.2215/CJN.17331120
Selby NM, Casula A, Lamming L, Stoves J, Samarasinghe Y, Lewington AJ, Roberts R, Shah N, Johnson M, Jackson N, Jones C, Lenguerrand E, McDonach E, Fluck RJ, Mohammed MA, Caskey FJ: An organizational-level program of intervention for AKI: A pragmatic stepped wedge cluster randomized trial. J Am Soc Nephrol 30: 505–515, 2019 https://doi.org/10.1681/ASN.2018090886
doi: 10.1681/ASN.2018090886
Karsanji DJ, Pannu N, Manns BJ, Hemmelgarn BR, Tan Z, Jindal K, Scott-Douglas N, James MT: Disparity between nephrologists’ opinions and contemporary practices for community follow-up after AKI hospitalization. Clin J Am Soc Nephrol 12: 1753–1761, 2017 https://doi.org/10.2215/CJN.01450217
doi: 10.2215/CJN.01450217
Greer RC, Liu Y, Crews DC, Jaar BG, Rabb H, Boulware LE: Hospital discharge communications during care transitions for patients with acute kidney injury: A cross-sectional study. BMC Health Serv Res 16: 449, 2016 https://doi.org/10.1186/s12913-016-1697-7
doi: 10.1186/s12913-016-1697-7
Siew ED, Parr SK, Abdel-Kader K, Eden SK, Peterson JF, Bansal N, Hung AM, Fly J, Speroff T, Ikizler TA, Matheny ME: Predictors of recurrent AKI. J Am Soc Nephrol 27: 1190–1200, 2016 https://doi.org/10.1681/ASN.2014121218
doi: 10.1681/ASN.2014121218
Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: The PrevAKI randomized controlled trial [published correction appears in Intensive Care Med 43: 1949, 2017]. Intensive Care Med 43: 1551–1561, 2017 https://doi.org/10.1007/s00134-016-4670-3
doi: 10.1007/s00134-016-4670-3
Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, Tolwani AJ, Waikar SS, Weisbord SD: KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 61: 649–672, 2013 https://doi.org/10.1053/j.ajkd.2013.02.349
doi: 10.1053/j.ajkd.2013.02.349
Brar S, Ye F, James MT, Hemmelgarn B, Klarenbach S, Pannu N; Interdisciplinary Chronic Disease Collaboration: Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with outcomes after acute kidney injury. JAMA Intern Med 178: 1681–1690, 2018 https://doi.org/10.1001/jamainternmed.2018.4749
doi: 10.1001/jamainternmed.2018.4749
Hsu CY, Liu KD, Yang J, Glidden DV, Tan TC, Pravoverov L, Zheng S, Go AS: Renin-angiotensin system blockade after acute kidney injury (AKI) and risk of recurrent AKI. Clin J Am Soc Nephrol 15: 26–34, 2020 https://doi.org/10.2215/CJN.05800519
doi: 10.2215/CJN.05800519
Hung AM, Siew ED, Wilson OD, Perkins AM, Greevy Jr RA, Horner J, Abdel-Kader K, Parr SK, Roumie CL, Griffin MR, Ikizler TA, Speroff T, Matheny ME: Risk of hypoglycemia following hospital discharge in patients with diabetes and acute kidney injury. Diabetes Care 41: 503–512, 2018 https://doi.org/10.2337/dc17-1237
doi: 10.2337/dc17-1237
Ibrahim J, Hazzan AD, Mathew AT, Sakhiya V, Zhang M, Halinski C, Fishbane S: Medication discrepancies in late-stage chronic kidney disease. Clin Kidney J 11: 507–512, 2018 https://doi.org/10.1093/ckj/sfx135
doi: 10.1093/ckj/sfx135
Phillips M, Wilson JA, Aly A, Wood M, Poyah P, Drost S, Hiltz A, Carver H: An evaluation of medication reconciliation in an outpatient nephrology clinic. CANNT J 26: 29–33, 2017
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS: Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA 281: 613–620, 1999 https://doi.org/10.1001/jama.281.7.613
doi: 10.1001/jama.281.7.613
Sullivan JL, Shin MH, Engle RL, Yaksic E, VanDeusen Lukas C, Paasche-Orlow MK, Starr LM, Restuccia JD, Holmes SK, Rosen AK: Evaluating the implementation of project re-engineered discharge (RED) in five veterans health administration (VHA) hospitals. Jt Comm J Qual Patient Saf 44: 663–673, 2018 https://doi.org/10.1016/j.jcjq.2018.01.007
doi: 10.1016/j.jcjq.2018.01.007
Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI: Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions. JAMA 316: 2647–2656, 2016 https://doi.org/10.1001/jama.2016.18533
doi: 10.1001/jama.2016.18533
Ortiz-Soriano V, Alcorn JL 3rd, Li X, Elias M, Ayach T, Sawaya BP, Malluche HH, Wald R, Silver SA, Neyra JA: A survey study of self-rated patients’ knowledge about AKI in a post-discharge AKI clinic. Can J Kidney Health Dis 6: 2054358119830700, 2019 https://doi.org/10.1177/2054358119830700
doi: 10.1177/2054358119830700