Transitional care program to facilitate recovery following severe acute kidney injury

• Published in: Journal of nephrology Vol. 32; no. 4; pp. 605 - 613
• Main Authors: Hong, Wei-Zhen, Haroon, Sabrina, Lau, Titus, Hui, Soh-Heng, Ma, Valerie, Goh, Jing-Xian, Chua, Horng-Ruey
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2019
• Subjects: Medicine; Medicine & Public Health; Nephrology; Original Article; Urology; Transitional care; Cardio-renal syndrome; Quality improvement; Weaning; Acute kidney injury; Multidisciplinary care; Hospitalization; Renal replacement therapy
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-019-00616-z

Background Patients with acute kidney injury needing prolonged renal replacement therapy (AKI-RRT) may benefit from a structured care process in form of an AKI transitional care program (ATCP), to facilitate RRT weaning and recovery. Methods We examined outcomes following ATCP implementation in adults with AKI-RRT from a tertiary institution (versus pre-ATCP controls), including mortality, cumulative hospital days, and renal function over one year; RRT and haemodialysis catheter days in initial 90 days. Results We studied 89 patients with age 62 ( ± 15) years. 47% had septic AKI, 20% cardiorenal syndrome, and 29% had baseline eGFR < 30 mL/min/1.73 m 2 . Comparing 45 ATCP patients with 44 controls: 64% and 45% received continuous RRT (CRRT) ( p  = 0.07), with comparable rates of heart failure (24% versus 25%), ICU care (67% versus 70%), RRT successfully weaned (71% versus 75%), respectively; corresponding mortality rates were 24% and 32% ( p  = 0.44), hospital days of 205 (197–213) and 223 (215–232) per 1000 patient-days alive over one year ( p  = 0.002); with comparable RRT and catheter days. Serial serum creatinine in months following RRT cessation were comparable between either survivor-group. On multivariate analysis, heart failure or having received CRRT independently predicted mortality and longer hospital days ( p  < 0.05); ATCP was independently associated with reduced hospital days ( p  < 0.001). 17 ATCP patients and 14 controls required outpatient RRT weaning, with catheter days of 607 (568–648) and 683 (638–731) per 1000 patient-days in initial 90 days, respectively ( p  = 0.01). Conclusions Implementing a structured care pathway in patients with AKI-RRT may help reduce hospitalization, and reduce haemodialysis catheter days in the subgroup for outpatient RRT weaning.