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Title: Transitional care program to facilitate recovery following severe acute kidney injury
Authors: Hong, WZ 
Haroon, S 
Lau, T
Hui, SH
Ma, V
Goh, JX
Chua, HR 
Keywords: Acute kidney injury
Cardio-renal syndrome
Multidisciplinary care
Quality improvement
Renal replacement therapy
Transitional care
Issue Date: 1-Jan-2019
Citation: Hong, WZ, Haroon, S, Lau, T, Hui, SH, Ma, V, Goh, JX, Chua, HR (2019-01-01). Transitional care program to facilitate recovery following severe acute kidney injury. Journal of Nephrology. ScholarBank@NUS Repository.
Abstract: © 2019, Italian Society of Nephrology. Background: Patients with acute kidney injury needing prolonged renal replacement therapy (AKI-RRT) may benefit from a structured care process in form of an AKI transitional care program (ATCP), to facilitate RRT weaning and recovery. Methods: We examined outcomes following ATCP implementation in adults with AKI-RRT from a tertiary institution (versus pre-ATCP controls), including mortality, cumulative hospital days, and renal function over one year; RRT and haemodialysis catheter days in initial 90 days. Results: We studied 89 patients with age 62 (± 15) years. 47% had septic AKI, 20% cardiorenal syndrome, and 29% had baseline eGFR < 30 mL/min/1.73 m 2 . Comparing 45 ATCP patients with 44 controls: 64% and 45% received continuous RRT (CRRT) (p = 0.07), with comparable rates of heart failure (24% versus 25%), ICU care (67% versus 70%), RRT successfully weaned (71% versus 75%), respectively; corresponding mortality rates were 24% and 32% (p = 0.44), hospital days of 205 (197–213) and 223 (215–232) per 1000 patient-days alive over one year (p = 0.002); with comparable RRT and catheter days. Serial serum creatinine in months following RRT cessation were comparable between either survivor-group. On multivariate analysis, heart failure or having received CRRT independently predicted mortality and longer hospital days (p < 0.05); ATCP was independently associated with reduced hospital days (p < 0.001). 17 ATCP patients and 14 controls required outpatient RRT weaning, with catheter days of 607 (568–648) and 683 (638–731) per 1000 patient-days in initial 90 days, respectively (p = 0.01). Conclusions: Implementing a structured care pathway in patients with AKI-RRT may help reduce hospitalization, and reduce haemodialysis catheter days in the subgroup for outpatient RRT weaning.
Source Title: Journal of Nephrology
ISSN: 1121-8428
DOI: 10.1007/s40620-019-00616-z
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