Early Comprehensive Kidney Care in Dialysis-Requiring Acute Kidney Injury Survivors: A Populational Study

Chun-Yi Wu; Jia-Sin Liu; Cheng-Hsu Chen; Chun-Te Huang; Tung-Min Yu; Ya-Wen Chuang; Shih-Ting Huang; Chih-Cheng Hsu; Ming-Ju Wu

doi:10.3389/fmed.2022.847462

Early Comprehensive Kidney Care in Dialysis-Requiring Acute Kidney Injury Survivors: A Populational Study

Front Med (Lausanne). 2022 Apr 22:9:847462. doi: 10.3389/fmed.2022.847462. eCollection 2022.

Authors

Chun-Yi Wu^{1

2}, Jia-Sin Liu³, Cheng-Hsu Chen^{1

4

5

6}, Chun-Te Huang⁷, Tung-Min Yu¹, Ya-Wen Chuang^{1

4

5

8}, Shih-Ting Huang^{1

4}, Chih-Cheng Hsu^{3

9

10

11}, Ming-Ju Wu^{1

5

12

13

14

15}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
² Department of Nursing, Asia University, Taichung, Taiwan.
³ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁴ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
⁵ Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁶ Department of Life Science, Tunghai University, Taichung, Taiwan.
⁷ Department of Internal Medicine and Critical Care Medicine, Nephrology and Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁸ Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.
⁹ Department of Health Services Administration, China Medical University, Taichung, Taiwan.
¹⁰ Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
¹¹ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan.
¹² RongHsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan.
¹³ Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
¹⁴ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁵ Graduate Institute of Clinical Medical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.

Abstract

Background: For patients with Acute Kidney Injury (AKI), a strong and graded relationship exists between AKI severity and mortality. One of the most severe entities of AKI is Dialysis-Requiring Acute Kidney Injury (D-AKI), which is associated with high rates of mortality and end-stage renal disease (ESRD). For this high-risk population group, there is a lack of evidence regarding optimal post-AKI care. We propose that post-AKI care through the combined efforts of the nephrologist and the multidisciplinary care team may improve outcomes. Our aim here is to study for survivors of dialysis-requiring acute kidney injury, the effects of implementing early comprehensive kidney care.

Methods: This is a retrospective longitudinal cohort study of Taiwanese through analyzing the National Health Insurance Research Database (NHIRD). We included patients with acute dialysis during hospitalization from January 1, 2015 to December 31, 2018. Propensity match was done at 1:1, including estimated glomerular filtration rate (eGFR) based on CKD-EPI which was performed due to large initial disparities between these two cohorts.

Results: After the propensity match, each cohort had 4,988 patients. The mean eGFR based on CKD-EPI was 27.5 ml/min/1.73 m², and the mean follow-up period was 1.4 years.The hazard ratio for chronic dialysis or ESRD was 0.55 (95% CI, 0.49-0.62; p < 0.001). The hazard ratio for all-cause mortality was 0.79 (95% CI, 0.57-0.88; p < 0.001). Both outcomes favored early comprehensive kidney care.

Conclusions: For survivors of dialysis-requiring acute kidney injury, early comprehensive kidney care significantly lowered risks of chronic dialysis and all-cause mortality.

Keywords: AKI follow-up; acute kidney injury; comprehensive kidney care; dialysis-requiring acute kidney injury; end-stage renal disease.