| アブストラクト | BACKGROUND: Acute kidney injury (AKI) is a clinical syndrome characterised by a sudden deterioration of kidney function. It is common and usually occurs as a complication of severe illness or major surgery. Despite the high risk of complications and a decade of improvement initiatives in the UK, little is known about the quality of post-discharge AKI care. Our population-based cohort study investigated adherence to guideline-recommended post-AKI care in general practices in England. METHODS: Using English hospital admission data (2017-2021), we created a cohort of discharged patients (>/= 18 years) with a hospital diagnostic code of AKI. Using linked Clinical Practice Research Datalink Aurum primary care data, we examined percentages of AKI episodes meeting the criteria of 14 guideline-recommended post-AKI care indicators, covering: AKI coding in primary care, post-discharge primary care contacts, kidney health and blood pressure monitoring, and guideline-indicated prescribing. Variations of indicator adherence according to patient characteristics were quantified using binomial mixed regression. RESULTS: 209,222 patients (48.0% females; mean age 74.1 years) were included, representing 279,187 AKI inpatient episodes. Only 19.5% (95% CI 18.5-20.5) of episodes had AKI coded in primary care within 30 days of discharge, while 72.6% (95% CI 71.8-73.4) had a documented contact with general practice. At 90 +/- 30 days after discharge, serum creatinine was measured in 34.2% (95% CI 33.7-34.8) of episodes, blood pressure in 34.6% (95% CI 34.0-35.1), and albumin-creatinine ratio in 4.2% (95% CI 4.0-4.4). Testing was less common amongst younger patients and those without comorbid conditions. Renin-angiotensin system inhibitor prescribing rates were low in patients likely to benefit. CONCLUSIONS: There are multiple missed opportunities for improving post-AKI care. Rates of measuring albuminuria were particularly low, despite its strong association with subsequent kidney and cardiovascular events. The limited post-AKI clinical activity amongst younger patients and those without comorbidities undermines the prevention and early intervention of chronic kidney diseases. Clearer discharge arrangements, including case-specific guidance on discharge summaries, and the development and evaluation of concerted implementation strategies spanning secondary and primary care are needed. |
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| 投稿者 | Mok, Pearl L H; Sawhney, Simon; Blakeman, Tom; Carr, Matthew J; Elliott, Rachel A; Foy, Robbie; Fraser, Simon Ds; Kontopantelis, Evangelos; Lewington, Andrew J P; Mahboub-Ahari, Alireza; Roderick, Paul; Selby, Nicholas M; Ashcroft, Darren M |
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| 組織名 | Centre for Pharmacoepidemiology & Drug Safety, Division of Pharmacy & Optometry,;Faculty of Biology, Medicine and Health, The University of Manchester,;Manchester, UK. pearl.mok@manchester.ac.uk.;NIHR Greater Manchester Patient Safety Research Collaboration, The University of;Manchester, Manchester, UK. pearl.mok@manchester.ac.uk.;Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK.;Manchester, Manchester, UK.;Division of Population Health, Health Services Research & Primary Care, The;University of Manchester, Manchester, UK.;Manchester, UK.;Manchester Centre for Health Economics, Division of Population Health, Health;Services Research & Primary Care, The University of Manchester, Manchester, UK.;Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.;School of Primary Care, Population Sciences and Medical Education, Faculty of;Medicine, University of Southampton, Southampton General Hospital, Southampton,;UK.;Division of Informatics, Imaging and Data Sciences, The University of Manchester,;Division of Family Medicine, Yong Loo Lin School of Medicine, National University;of Singapore, Singapore, 119228, Singapore.;Centre for Research in Health Systems Performance, National University of;Singapore, Singapore, Singapore.;Leeds Teaching Hospitals NHS Trust, Leeds, UK.;Centre for Kidney Research and Innovation, Academic Unit of Translational Medical;Sciences, School of Medicine, University of Nottingham, Nottingham, UK. |
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