Disparity Seen in Nephrology Follow-Up Care
Nephrologists recommend follow-up after AKI hospitalization much more often than it occurs
FRIDAY, Oct. 13, 2017 (HealthDay News) -- There is a large disparity between the reported clinical opinions of nephrologists and real-world care for nephrology evaluation of patients after hospitalization with severe acute kidney injury (AKI), according to a study published online Oct. 12 in the Clinical Journal of the American Society of Nephrology.
Divya Karsanji, M.D., from the University of Calgary in Canada, and colleagues surveyed 145 nephrologists using a series of clinical vignettes of patients hospitalized with severe AKI. Respondents were asked to rank their likelihood of recommending follow-up for each patient after hospital discharge. The responses were compared with administrative health data on rates of community follow-up with nephrologists for patients hospitalized with AKI in Alberta, Canada, between 2005 and 2014.
The researchers found that the nephrologists surveyed indicated they would definitely or probably re-evaluate patients in 87 percent of the scenarios provided, with a higher likelihood of follow-up for patients with a history of pre-existing CKD (89 percent), heart failure (92 percent), receipt of acute dialysis (91 percent), and less complete recovery of kidney function (98 percent). However, only 24 percent of patients with similar characteristics were seen by a nephrologist in Alberta within one year after a hospitalization with AKI. There was a trend toward lower rates of follow-up over more recent years of the study. Among patients over the age of 80 years, follow-up with a nephrologist was significantly less common (20 percent) versus patients with pre-existing CKD (43 percent) or with a nephrology consultation before or during AKI hospitalization (78 percent and 41 percent, respectively).
"There is a substantial disparity between the opinions of nephrologists and actual processes of care for nephrology evaluation of patients after hospitalization with severe AKI," conclude the authors.