Nephrologist follow-up improves outcomes after hospitalization with acute kidney injury

INTRODUCTION: Acute kidney injury (AKI) is a common medical condition for patients during hospitalization and is associated with long-term sequelae. The incidence of AKI is increasing, whereas in-hospital mortality from the condition is decreasing. We compared outcomes following discharge in patients with AKI between those who received follow-up with nephrologists and those who only received routine follow-up (i.e., follow-up not at the nephrology department). MATERIALS AND METHODS: This retrospective cohort study identified 66,859 AKI survivors with discharge eGFR values of less than 60 mL/min/1.73 m² from January 1, 2004, to June 30, 2019. Patients were categorized by follow-up department after discharge into nephrology and non-nephrology groups during the 6-month exposed period. The clinical outcomes included all-cause death, cardiovascular death, heart failure, readmission with AKI, and new-onset dialysis. RESULTS: AKI survivors who received 3 years of follow-up at a nephrology department had significantly lower rates of all-cause death (hazard ratio [HR]: 0.91; 95% CI: 0.87 to 0.96), cardiovascular death (HR: 0.82; 95% CI: 0.75 to 0.90), and readmission with AKI (HR: 0.82; 95% CI: 0.77 to 0.87) but higher rates of heart failure (HR: 1.13; 95% CI: 1.05 to 1.21) and new-onset dialysis (HR: 1.67; 95% CI: 1.43 to 1.95) than did those who received routine follow-up at non-nephrology department. CONCLUSIONS: Following discharge, patients with AKI during hospitalization, especially severe AKI, are at significantly lower risk of all-cause death, cardiovascular death, and readmission with AKI if they receive follow-up at a nephrology department compared with non-nephrology follow-up.