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Patients with AKI, especially those admitted to the ICU, are at a high risk of clinical complications and readmission after hospital discharge. The aim of this study was to establish a specialized follow-up outpatient clinic for survivors of AKI episodes and to assess the progression of their renal function, readmission rates, and mortality.
A prospective study conducted at a tertiary and university hospital with outpatient follow-up of patients who developed AKI during their hospitalization. Inclusion criteria were patients with 18 years or older, who had nephrologist consultation during their hospital stay and had AKI KDIGO stages 2 or 3. Follow-up time was 1 year.
In that period, 276 patients are under follow-up, 63.4% are male and the median age is 59 [45-70] years. Of the total of patients, 43.5% had hypertension, 24.3% diabetes, 15.57% malignancies, 9.4% coronary artery disease, and 9.0% heart failure. The etiology of AKI was identified as acute tubular necrosis in 56.9%, associated with nephrotoxicity in 51.4%, attributed to sepsis in 51.4%, and post-renal in 7.2%. Among these, 118 (42.7%) required ICU admission, 88 (31.9%) required mechanical ventilation, 90 (32.6%) needed vasopressor drugs, and 86 (31.1%) underwent renal replacement therapy. The median baseline, maximum, and discharge creatinine levels were 1.0 (0.8-1.5) mg/dL, 5.10 (3.5-6.55) mg/dL, and 2.50 (1.80-3.20) mg/dL, respectively.
During outpatient follow-up, the median creatinine levels were 1.60 (1.20-2.40) mg/dL, 1.50 (1.10 – 2.20) mg/dL, and 1.70 (1.12 – 2.45) mg/dL at 30 days, 6 months, and 1 year after hospital discharge, respectively. Additionally, 21.73% of patients had a positive microalbuminuria 30 days after hospital discharge. Among patients who were not previously hypertensive, 5 (3.20%) developed hypertension requiring medication within 30 days of hospital discharge. The readmission rate at 30 and 90 days was 12.0% and 11.4%, respectively. Two patients (0.72%) initiated dialysis, and 6 (2.17%) passed away during the outpatient follow-up period.
The analyzed population exhibits persistent renal dysfunction and microalbuminuria during outpatient follow-up of critically ill patients with hospital-acquired AKI. The establishment of the post-hospital AKI outpatient clinic is part of a strategy aimed at enhancing patient care throughout the entire AKI journey.