Department of Paediatrics, Division of Paediatric Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Pediatr Res. 2022 Jan;91(1):209-217. doi: 10.1038/s41390-021-01414-9. Epub 2021 Mar 17.
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.
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.
AKI (KDIGO (Kidney Disease: Improving Global Outcomes) definitions).
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.
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.
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.
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.
鲜有研究描述儿科急性肾损伤（AKI）患儿的门诊随访情况。本研究旨在描述儿科重症监护病房（PICU）出院后 AKI 的门诊随访情况。
这是一项回顾性的、多中心队列研究（0-18 岁；PICU 幸存者（2003-2005 年）；非心脏手术；无基线肾脏疾病）。利用省级行政数据库确定结局。
AKI（KDIGO（改善全球肾脏病预后组织）定义）。
出院后肾脏科、家庭医生、儿科医生和非肾脏科专家的就诊情况。采用回归分析评估 AKI 幸存者中与肾脏科随访（Cox）和肾脏科、家庭医生或儿科医生就诊次数（泊松）相关的因素。
在纳入的 2041 例患儿中，355 例（17%）有任何 AKI；64/355 例（18%）有肾脏科随访；198/355 例（56%）有家庭医生或儿科医生随访；338/355 例（95%）在出院后 1 年内有家庭医生、儿科医生或非肾脏科专家的随访。仅有 44/142 例（31%）2-3 期 AKI 患儿在出院后 1 年内有肾脏科随访。住院期间肾脏科会诊（调整后的危险比[aHR]7.76[95%置信区间[CI]4.89-12.30]）、肾脏入院诊断（aHR 4.26[2.21-8.18]）和出院时 AKI 未恢复（aHR 2.65[1.55-4.55]）与任何 AKI 幸存者的 1 年肾脏科随访相关。
AKI 患儿的肾脏科随访并不常见，但几乎所有 AKI 幸存者都接受了非肾脏病医生的随访。这表明，针对非肾脏病医生的 AKI 随访知识转化策略应成为优先事项。
AKI 患儿有发生慢性肾脏病（CKD）和高血压的长期高风险，因此 AKI 后应定期进行肾脏健康监测。然而，目前关于 AKI 后随访的数据有限，包括与肾脏科转诊相关的因素以及非肾脏病科随访的范围。我们发现，只有五分之一的 AKI 幸存者和三分之一的严重 AKI（2-3 期）幸存者在出院后 1 年内接受了肾脏科随访。然而，95%的患儿在出院后 1 年内接受了家庭医生、儿科医生或非肾脏科专家的随访。这表明，AKI 随访知识转化策略应针对非肾脏病科医护人员。
