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Discharge Documentation and Follow-Up of Critically Ill Patients With Acute Kidney Injury Treated With Kidney Replacement Therapy: A Retrospective Cohort Study

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Xin Yi Choon, Nuttha Lumlertgul, Lynda Cameron, Andrew Jones, Joel Meyer, Andrew Slack, Helen Vollmer, Nicholas A. Barrett, Richard Leach, Marlies Ostermann

Original languageEnglish
Article number710228
JournalFrontiers in Medicine
Volume8
Early online date14 Sep 2021
DOIs
E-pub ahead of print14 Sep 2021
Published14 Sep 2021

Bibliographical note

Funding Information: The authors would like to thank Linda Tovey and Alison A. Dixon for their help in data extraction. The authors would also like to thank ICU staff and renal critical care nurses for their excellent care in providing continuous kidney replacement therapy for ICU patients. We are also grateful to the pharmacy team in obtaining medication conciliation for ICU survivors. Publisher Copyright: © Copyright © 2021 Choon, Lumlertgul, Cameron, Jones, Meyer, Slack, Vollmer, Barrett, Leach and Ostermann. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Leading organisations recommend follow-up of acute kidney injury (AKI) survivors, as these patients are at risk of long-term complications and increased mortality. Information transfer between specialties and from tertiary to primary care is essential to ensure timely and appropriate follow-up. Our aim was to examine the association between completeness of discharge documentation and subsequent follow-up of AKI survivors who received kidney replacement therapy (KRT) in the Intensive Care Unit (ICU). We retrospectively analysed the data of 433 patients who had KRT for AKI during ICU admission in a tertiary care centre in the UK between June 2017 and May 2018 and identified patients who were discharged from hospital alive. Patients with pre-existing end-stage kidney disease and patients who were transferred from hospitals outside the catchment area were excluded. The primary objective was to assess the completeness of discharge documentation from critical care and hospital; secondary objectives were to determine cardiovascular medications reconciliation after AKI, and to investigate kidney care and outcomes at 1 year. The development of AKI and the need for KRT were mentioned in 85 and 82% of critical care discharge letters, respectively. Monitoring of kidney function post-discharge was recommended in 51.6% of critical care and 36.3% of hospital discharge summaries. Among 35 patients who were prescribed renin-angiotensin-aldosterone system inhibitors before hospitalisation, 15 (42.9%) were not re-started before discharge from hospital. At 3 months, creatinine and urine protein were measured in 88.2 and 11.8% of survivors, respectively. The prevalence of chronic kidney disease stage III or worse increased from 27.2% pre-hospitalisation to 54.9% at 1 year (p < 0.001). Our data demonstrate that discharge summaries of patients with AKI who received KRT lacked essential information. Furthermore, even in patients with appropriate documentation, renal follow-up was poor suggesting the need for more education and streamlined care pathways.

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