Identification of barriers to patient education and awareness following dialysis-requiring AKI

Abstract

Background: Survivors of acute kidney injury (AKI) requiring dialysis remain at high risk for adverse outcomes, including both recurrent AKI and mortality. Patient awareness and education are prerequisites to pursuing kidney-protective behaviors as a potential approach to improve post-AKI outcomes. The goals of this study were to assess post-AKI awareness and follow-up among patients who suffered AKI-D, and to identify barriers and opportunities to improve post-AKI patient education. Methods: We conducted a single-center, retrospective study of patients hospitalized in 2021 who survived AKI-D and no longer required dialysis upon discharge. Patients with end-stage kidney disease (ESKD), kidney transplant recipients, and hospice-bound patients were excluded. Charts were reviewed to identify documentation of AKI patient education and follow-up instructions. Patient AKI knowledge was assessed using a survey administered via text or phone call. Results: A total of 91 eligible patients were identified. At one year, post-discharge mortality was 11%, and 34% of survivors had received nephrology follow-up. A diagnosis of AKI was documented on the patient after-visit summary for 54% of patients. Among surveyed patients, 20% were unaware of their AKI. No patients described themselves as very knowledgeable about their AKI or current kidney health. Patient-reported barriers to nephrology follow-up included lack of knowledge regarding how to set up an appointment and competing priorities including other healthcare appointments and non-healthcare obligations. Conclusions: One in five AKI-D patients were unaware of their AKI diagnosis. We identified several potential opportunities to improve post-AKI education, including more consistent education and follow-up processes.