Postacute AKI Follow-Up Reduces 30-Day Readmission Rate

Background: Acute kidney injury (AKI) is a frequent hospital complication which is associated with high rates of rehospitalization, mortality, and increased healthcare cost (estimated at $9,230* per readmission after AKI). Furthermore, guideline-directed medical therapies and diuretics are often stopped or reduced during an episode of AKI which has been shown to worsen patient outcomes. We developed an AKI follow-up clinic to provide post-acute care to this vulnerable population which historically has received little nephrology care after discharge. Methods: Education regarding the AKI follow-up clinic was provided to the hospital medicine providers, and referrals were made via the electronic medical record approximately 24-48 hours prior to discharge. Patients were scheduled within 7-21 days of discharge, depending on their clinical status and anticipated needs. The focus for this clinic was to assess the degree of renal recovery after AKI, coordinate ongoing nephrology care if indicated, and reinitiate nephroprotective medications and diuretics as appropriate. Results: The 30-day readmission rate for patients with AKI was reduced from a historical average of 19.4% to 10.0% in those patients who attended the AKI follow-up clinic. Over 99% of AKI clinic patients underwent a clinic intervention, including diagnostic testing and/or medication changes. We identified a sub-group of AKI survivors who were particularly high-risk for readmission: patients who were over 65 years-old and had either congestive heart failure or cirrhosis. Conclusion: Providing prompt subspecialty follow-up care for AKI survivors reduced the risk of 30-day readmission in this population. The AKI clinic provided an opportunity to resume diuretics and guideline-directed medical therapy in a timely manner.