Dr Benjamin Griffin Identifies Risk Factors Associated With Hospital Readmission Following AKI

People who experience acute kidney injuries (AKIs) in the hospital have higher rates of cardiac disease and death compared with those who have been discharged, said Benjamin Griffin, MD, a nephrologist and assistant professor of internal medicine at the University of Iowa.

Transcript:

Why did you decide to investigate acute kidney injury (AKI) in veterans in particular?

There's been a lot of recent work in the area of post-discharge AKI outcomes, a lot of that work coming out of Canada and from the Veterans Affairs system from several groups. What we've found is that people with kidney injury in the hospital, whereas in the past, we might have thought that if their creatinine recovers to normal, they do just fine, we found that they actually do not do nearly as well as people who did not have acute kidney injury in hospital. They have much higher rates of chronic kidney disease and end stage renal disease, which might be expected. But also, surprisingly, higher rates of cardiac disease, which is what we focused on in this study, and higher rates of death. This is a group that's at a lot of risk when it leaves the hospital, which previously was not really identified as a high-risk group, I don't think.

What were the risk factors for mortality and hospital readmission following AKI? Were any unexpected?

We didn't look specifically at mortality. We have plans to ultimately look at people who developed kidney disease, people who developed mortality. In this one, we were interested in heart disease, actually, people who developed readmissions for heart disease following an acute kidney injury. We defined a cardiac readmission as myocardial infarction or congestive heart failure or ischemic stroke. Those were kind of our 3 outcomes. We looked primarily at risk factors for readmission with these cardiac indications. Perhaps this isn't surprising, but I think what struck me was that the people that already had congestive heart failure and atrial fibrillation, myocardial infarction, were significantly more likely, as were people with higher baseline creatinine, and diabetes. I think that, what that kind of suggested to me anyway, is that there's this group of people that we know are at high risk, based on the fact that they've had AKI and they have existing heart failure. They're not, as far as we can tell, receiving the care they need necessarily when they leave the hospital. I think this is a group we've identified that needs closer follow-up when they leave the hospital, in order to prevent some of these complications.

What can be done to mitigate these risk factors?

I think there is quite a bit and there's increasing literature about what exactly should be done for these people. It's been demonstrated that close nephrology follow-up especially, is useful in preventing readmissions and development of disease. But even things like making sure that people are restarting their angiotensin-converting enzyme (ACE) inhibitors when they leave the hospital, which are often stopped in the setting of kidney injury would be one. Making sure that patients are not becoming adenomatous or volume overloaded, making sure that they're meeting all their guidelines in terms of statin use and these sorts of things. I think there's a lot we can do in optimizing medication, and just keeping a close eye on the clinical status of these patients that can do them quite a bit of good in the long run.

Do you have any final thoughts you would like to share?

To wrap up, I think this is a group that's clearly at high risk. It remains to be seen if they're at risk because of the acute kidney injury episode, or if they're a group that was already at risk, as evidenced by the acute kidney injury episode. There's a lot of exciting work still to be done in the field. But I think at the very least, we can say this is a group that is at high risk, that isn't identified as such, I think broadly in the community. These people should be targeted for closer follow-up than just your typical admission I would say.