Back
Acute kidney injury (AKI) is a frequent entity between hospitalized patients and has a higher risk of morbidity and mortality associated among other parameters with the lack of follow-up after hospital discharge.The mortality risk depends on the severity of the renal impairment and if dialysis was required or not.The nephrological follow-up after hospital discharge of patients who have had an AKI episode, could demonstrate better results in the kidney function evolution or maintain them without dialysis. We have to encourage physicians to consider the early consultation of the patients with AKI and be sure that discharged patients will continue follow-up by a nephrologist. The main objective of this study is to evaluate the kidney function evolution in a group of patients with AKI according to their comorbidities and the nephrological follow up in a period of time
Retrospective, observational study of a group of patients hospitalized between Jul-Dec 2015 in our hospital. We collected 1068 patients with impaired renal function defined as a serum creatinine value greater than 1,2 mg/dl testing by the Jaffre method. We evaluated de morbility, the evolution of the renal function, the number of AKI events, dialysis needs, if they have or not nephrological follow up and the mortality until Feb 2020. We took into account the consults in the clinical and surgical areas were taken into account; patients admitted to critical areas were excluded.
We analyzed the data from hospitalized patients with AKI during 2015 and the follo up of them after hospital discharge until Feb 2020. We took into account the value of the serum creatinine at hospitalization and at the cutoff date. Of the total of 1068 analyzed patients 316 died (29,6%), 250 patients were lost (23,4%) and in the remaining 502 patients (47%) we could analyze de creatinine values. The mean age of the evaluated patients (502) was 66,1+/-12,6 years old with a prevalence of 83% of men and 17% of women. T statistical analysis was used for paired or independent samples (95% CI). The average value of the serum creatinine at hospitalization was 1,7+/-1,03 and at Feb 2020 it was 1,81+/-1,57 (p<0,000). Of the total of 502 patients, 333 didn’t have any nephrological follow up (66,3%) and 168 patients (33,7%) had it. The discharged patients without nephrological follow up had a serum creatinine value of 1,61 mg/dl +/- 0,69 at hospitalization and 1,45 mg/dl +/-1,07 at the cutoff date (p<0,000–1,951E-29) while among patients with follow up after discharged, the serum creatinine value was 2,08+/-1,7mg/dl at the beginning and 2,50 mg/dl +/-4,53 at the end of the study (p<0,000–6,426E-19). Among patients who received nephrological follow up 28 (16,67%) needed chronic renal replacement therapy (RRT) during that period while 83,33% didn’t need it. Of the patients who received RRT 96% were hypertensive, 71% diabetic, 71% were men and the average age was 64,8+/-7,02 years old. The mortality rate was 29,6% (317 among the total of 1068). In this group the mean of the initial serum creatinine value was 2,64+/-9,81. 32 patients needed dialysis at the beginning. The average age was 73,46+/-13,57 years old, being 30% women and 70% men, 29% were diabetic and 74,4% were hypertensive. The annualized mortality rates were: Patients ≤ 90 days: TMA among prevalent patients with AKI in 2015: 9,27%, Patientes ≤ 90 days TMA among deceased patients with AKI in 2015: 56,91%
In our study the group of patients with nephrological follow-up, 83% didn’t need RRT at any moment during the 5 years of the study. The initial serum creatinine values of the group without follow-up were statistically lower than those of the group with follow-up. We could see that those patients with AKI who continue follow-up by a nephrologist keep without RRT in 83 % of patients after 5 years of follow up. In spite of being well known that the impaired renal function, even though it is transient, is a risk factor for the development of chronic renal disease, the importance of this elevation is still nowadays undervalued. Therefore, we should implement medical conducts, directed to stimulate the referrals of the patients to the specialist