Transitional care program to facilitate recovery following severe acute kidney injury
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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.
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.
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 m2. 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).
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.
KeywordsAcute kidney injury Cardio-renal syndrome Hospitalization Multidisciplinary care Quality improvement Renal replacement therapy Transitional care Weaning
Research idea and study design: WZH, HRC; ATCP physicians: HRC, SWH, TL; ATCP nursing: SHH, JXG; data acquisition: WZH, VM, HRC; data analysis/interpretation: WZH, HRC; statistical analysis: WZH, HRC; supervision and mentorship: HRC; drafting of manuscript: WZH, HRC; Each author contributed important intellectual content during manuscript revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. WZH and HRC take responsibility that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted, and that any discrepancies from the study as planned have been explained.
The authors have no financial interests to declare. No external funding contributed to this work.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study was approved by the National Healthcare Group Domain Specific Review Board (NHG-DSRB2016/01,169).
In view of the retrospective design of the study, the need for informed consent was waived. Data used in this study was de-identified and made anonymous.
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