Division of Nephrology, Department of Medicine.
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Clin J Am Soc Nephrol. 2017 Nov 7;12(11):1753-1761. doi: 10.2215/CJN.01450217. Epub 2017 Oct 12.
Recent guidelines suggest that patients should be evaluated after AKI for resolution versus progression of CKD. There is uncertainty as to the role of nephrologists in this process. The objective of this study was to compare the follow-up recommendations from nephrologists with contemporary processes of care for varying scenarios of patients hospitalized with AKI.
DESIGN, SETTING PARTICIPANTS, & MEASUREMENTS: We surveyed Canadian nephrologists using a series of clinical vignettes of patients hospitalized with severe AKI and asked them to rank their likelihood of recommending follow-up for each patient after hospital discharge. We compared these responses with administrative health data on rates of community follow-up with nephrologists for patients hospitalized with AKI in Alberta, Canada between 2005 and 2014.
One hundred forty-five nephrologists participated in the survey (46% of the physician membership of the Canadian Society of Nephrology). Nephrologists surveyed indicated that they would definitely or probably re-evaluate patients in 87% of the scenarios provided, with a higher likelihood of follow-up for patients with a history of preexisting CKD (89%), heart failure (92%), receipt of acute dialysis (91%), and less complete recovery of kidney function (98%). In contrast, only 24% of patients with similar characteristics were seen by a nephrologist in Alberta within 1 year after a hospitalization with AKI, with a trend toward lower rates of follow-up over more recent years of the study. Follow-up with a nephrologist was significantly less common among patients over the age of 80 years old (20%) and more common among patients with preexisting CKD (43%) or a nephrology consultation before or during AKI hospitalization (78% and 41%, 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.
最近的指南建议，对于急性肾损伤（AKI）后慢性肾脏病（CKD）的缓解或进展，应评估患者。但对于肾病医生在这一过程中的作用尚存在不确定性。本研究的目的是比较肾病医生的随访建议与因不同 AKI 住院患者的具体情况而异的现行治疗方案。
设计、地点、参与者和测量方法：我们使用一系列严重 AKI 住院患者的临床病例对加拿大的肾病医生进行了调查，并要求他们对每位患者出院后的随访可能性进行排序。我们将这些答复与 2005 年至 2014 年加拿大艾伯塔省 AKI 住院患者的社区随访与肾病医生的管理健康数据进行了比较。
共有 145 名肾病医生参与了调查（占加拿大肾脏病学会医师会员的 46%）。调查的肾病医生表示，他们肯定或可能会重新评估提供的 87%的情况下的患者，而对有预先存在的 CKD（89%）、心力衰竭（92%）、接受急性透析（91%）和肾功能恢复不完全（98%）病史的患者进行随访的可能性更高。相比之下，在艾伯塔省 AKI 住院后 1 年内，仅有 24%具有类似特征的患者接受了肾病医生的治疗，且随着研究年限的推移，随访率呈下降趋势。在 80 岁以上的患者中，与肾病医生进行随访的比例明显较低（20%），而在预先存在 CKD（43%）或在 AKI 住院前或住院期间进行了肾病会诊的患者中（分别为 78%和 41%），与肾病医生进行随访的比例更高。
肾病医生的意见与 AKI 住院患者的肾病评估实际治疗方案之间存在显著差异。
