Go to content

Association of an acute kidney injury follow-up clinic with patient outcomes and care processes: a cohort study


Rationale and Objective — To determine whether attendance at an acute kidney injury (AKI) follow-up clinic is associated with reduced major adverse kidney events.

Study Design — Propensity-Matched Cohort study.

Setting and Participants — Patients hospitalized with AKI in Ontario, Canada, from February 1, 2013, to September 30, 2017, at a single clinical center discharged not dependent on dialysis.

Exposure — Standardized assessment by a nephrologist.

Outcomes — Time to a major adverse kidney event, defined as death, initiation of maintenance dialysis, or incident/progressive chronic kidney disease.

Analytical Approach — Propensity-scores were used to match each patient who attended an AKI follow-up clinic to four patients who received standard care. Cox proportional hazard models were fit to assess the association between the care within an AKI follow-up clinic and outcomes. To avoid immortal time bias, we randomly assigned index dates to the comparator group.

Results — We matched 164 patients from the AKI follow-up clinic to 656 patients who received standard care. Over a mean (SD) follow-up of 2.2 (1.3) years, care in the AKI follow-up clinic was not associated with a reduction in major adverse kidney events relative to standard care (22.1 versus 24.7 events per 100 patient-years, HR 0.91, 95% CI 0.75-1.11). The AKI follow-up clinic was associated with a lower risk of all-cause mortality (HR 0.71, 95% CI 0.55-0.91). Patients ≥66 years who attended the AKI follow-up clinic were more likely to receive beta-blockers (HR 1.34, 95% CI 1.02-1.77) and statins (HR 1.35, 95% CI 1.05-1.74), but not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR 1.21, 95% CI 0.94-1.56).

Limitations — Single-center study and residual confounding.

Conclusions — Specialized post-discharge follow-up for AKI survivors was not associated with a lower risk of major adverse kidney events but was associated with a lower risk of death and increased prescriptions for some cardioprotective medications.



Silver SA, Adhikari NK, Jeyakumar N, Luo B, Harel Z, Dixon SN, Brimble KS, Clark EG, Neyra JA, Vijayaraghavan BKT, Garg AX, Bell CM, Wald R. Am J Kidney Dis. 2023; 81(5):554-63. Epub 2022 Dec 12.

View Source

Associated Sites