Acute kidney injury in the pediatric intensive care unit: outpatient follow-up

Abstract

BACKGROUND: Few studies have characterized follow-up after pediatric acute kidney injury (AKI). Our aim was to describe outpatient AKI follow-up after pediatric intensive care unit (PICU) admission. METHODS: Two-center retrospective cohort study (0–18 years; PICU survivors (2003–2005); noncardiac surgery; and no baseline kidney disease). Provincial administrative databases were used to determine outcomes. Exposure: AKI (KDIGO (Kidney Disease: Improving Global Outcomes) definitions). Outcomes: post-discharge nephrology, family physician, pediatrician, and non-nephrology specialist visits. Regression was used to evaluate factors associated with the presence of nephrology follow-up (Cox) and the number of nephrology and family physician or pediatrician visits (Poisson), among AKI survivors. RESULTS: Of n = 2041, 355 (17%) had any AKI; 64/355 (18%) had nephrology; 198 (56%) had family physician or pediatrician; and 338 (95%) had family physician, pediatrician, or non-nephrology specialist follow-up by 1 year post discharge. Only 44/142 (31%) stage 2–3 AKI patients had nephrology follow-up by 1 year. Inpatient nephrology consult (adjusted hazard ratio (aHR) 7.76 [95% confidence interval (CI) 4.89–12.30]), kidney admission diagnosis (aHR 4.26 [2.21–8.18]), and AKI non-recovery by discharge (aHR 2.65 [1.55–4.55]) were associated with 1-year nephrology follow-up among any AKI survivors. CONCLUSIONS: Nephrology follow-up after AKI was uncommon, but nearly all AKI survivors had follow-up with non-nephrologist physicians. This suggests that AKI follow-up knowledge translation strategies for non-nephrology providers should be a priority. Impact: Pediatric AKI survivors have high long-term rates of chronic kidney disease (CKD) and hypertension, justifying regular kidney health surveillance after AKI.However, there is limited pediatric data on follow-up after AKI, including the factors associated with nephrology referral and extent of non-nephrology follow-up.We found that only one-fifth of all AKI survivors and one-third of severe AKI (stage 2–3) survivors have nephrology follow-up within 1 year post discharge.However, 95% are seen by a family physician, pediatrician, or non-nephrology specialist within 1 year post discharge.This suggests that knowledge translation strategies for AKI follow-up should be targeted at non-nephrology healthcare providers.