Kidney Disease Awareness and Knowledge among Survivors ofAcute Kidney Injury

Abstract

Background: Acute kidney injury (AKI) survivors are at risk for chronic kidney disease, recurrent AKI, and cardiovascular disease. The transition from hospital to ambulatory care is an opportunity to reduce these sequelae by launching self-care plans through effective patient education. How well AKI survivors are informationally prepared to apply kidney-specific self-care is unknown. The purpose of this study was to identify awareness and disease-specific knowledge among AKI survivors. Methods: We performed a cross-sectional survey of AKI-related awareness and knowledge in 137 patients with Kidney Disease Improving Global Outcomes Stage II or III AKI near the time of hospital discharge. Patients were asked (1) “Did you experience AKI while in the hospital?” and (2) “Do you have a problem with your kidney health?” Objective knowledge of AKI was evaluated with a 15-item adapted version of the validated Kidney Knowledge Survey that included topics such as common causes, risk factors, and how AKI is diagnosed. Results: Median age was 54 (interquartile range 43–63) and 81% were white. Eighty percent of patients were unaware that they had experienced AKI and 53% were both unaware they had experienced AKI or had a “problem with their kidneys.” Multivariable logistic regression identified being male and lack of nephrology consult as predictors of unawareness with ORs of 3.92 (95% CI 1.48–10.33) and 5.10 (95% CI 1.98–13.13), respectively. Less than 50% recognized nonsteroidal anti-inflammatory drugs, contrast, or phosphate-based cathartics as risk factors for AKI. Two-thirds of patients did not agree that they knew a lot about AKI and more than 80% desired more information. Conclusions: Most patients with moderate to severe AKI are unaware of their condition, lack understanding of risk factors for recurrent AKI, and desire more information. Patient-centered communication to optimize awareness, understanding, and care will require coordinated educational strategies throughout the continuum of AKI care.

Nephrologist Follow-Up versus Usual Care after an Acute Kidney Injury Hospitalization (FUSION): A Randomized Controlled Trial

“…Patient characteristics by treatment group were similar, except those in the early nephrologist arm were slightly younger (mean6SD, 64610 versus 67612 years), were less likely to have preexisting heart failure (18% versus 30%) and hypertension (56% versus 78%), and had a shorter length of hospital stay (median [IQR], 11 [7][8][9][10][11][12][13][14][15][16][17][18][19] versus 16 [10][11][12][13][14][15][16][17][18][19][20][21][22] days). They were also more likely to have experienced KDIGO stage 3 AKI (68% versus 54%; Table 1).…”

Long-Term Outcomes in Patients with Acute Kidney Injury

“…Communication between health care providers and patients is also important. A recent observational study of 137 patients with moderate to severe AKI showed that 80% of patients were unaware of their diagnosis (71), and it is estimated that less than half of hospital discharge documentation records AKI (72,73). There is, therefore, a significant opportunity to develop and test different approaches to post-AKI care, as well as to work to improve recognition and communication.…”

“…Considering the high incidence of AKI and improvements in short-term survival (74), these long-term sequelae of AKI present a major unmet clinical need, with no proven interventions or data to inform optimal care provision. Patients often receive no follow-up after hospital discharge (16), and they often do not realize that they have had AKI (71,75). The evidence base describing the long-term sequelae of AKI continues to grow, adding to our understanding and increasing awareness of these issues.…”

Characteristics and Outcomes of Survivors of Critical Illness and Acute Kidney Injury Followed in a Pilot Acute Kidney Injury Clinic

“…Surprisingly, 80% of AKI survivors were unaware of their condition by the time of discharge, and 21% were unaware of their AKI diagnosis at the first AKI Clinic visit. 5,6 The AKI survivors were also shown to be at higher risk for rehospitalization than their counterparts without AKI. A population-based study showed that 18% of AKI survivors were readmitted within the first 30 days of discharge.…”