Nephrology Referral Low Following Acute Kidney Injury

Cumulative incidence of referral 8.5 percent before dying, dialysis, or improved kidney function

FRIDAY, Dec. 9 (HealthDay News) -- Following an acute kidney injury (AKI), most patients at risk for subsequent decline in kidney function are not referred to a kidney specialist, according to a study published online Dec. 8 in the Journal of the American Society of Nephrology.

Edward D. Siew, M.D., from the Vanderbilt University Medical Center in Nashville, Tenn., and colleagues investigated the nephrology referral rates among 3,929 survivors (median age, 73 years) of AKI at risk for subsequent decline in kidney function, who were hospitalized between 2003 and 2008. All included patients had an estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m² at 30 days after peak injury. Patients were followed-up for 12 months to assess time to referral, with improved kidney function (eGFR ≥60 ml/min per 1.73 m²), dialysis initiation, and mortality considered as competing risks.

The investigators found that 60 percent of the patients had kidney dysfunction before admission to the hospital (baseline eGFR <60 ml/min per 1.73 m²). During the surveillance period, 22 percent of the patients died. The cumulative incidence of nephrology referral was 8.5 percent before dying, initiating dialysis, or experiencing an improvement in kidney function. Referral rates remained unaffected by the severity of AKI.

"These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI," the authors write.

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