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Acute Kidney Injury Patients Remain at Risk After ED Discharge

Discharging patients from the emergency department with acute kidney injury (AKI) might be riskier than clinicians realize.

A new study published online by the Clinical Journal of the American Society of Nephrology suggests that those patients remain at an increased risk of dying within 30 days.

The authors, led by London Health Sciences Centre researchers, point out that the negative health effects associated with AKI for patients who are hospitalized are understood fairly well, but less information is available about those who are not admitted.

To remedy that, the investigators conducted a population-based retrospective study in Canada from 2003 to 2012, matching 4,379 patients who presented to the ED with AKI and were discharged home to 4,379 patients who presented with AKI and were hospitalized.

At the same time, they matched 6,188 patients discharged home from the ED with AKI to 6,188 patients discharged home with no AKI.

Overall, there were 6,346 ED discharges of patients with AKI, and results indicate that within 30 days 149 patients (2%) died, 22 (0.3%) received acute dialysis, and 1,032 (16%) were hospitalized.

The report points out that, among patients with stage 2 and stage 3 — moderate and severe — AKI, 5% and 16% died within 30 days, respectively. Meanwhile, AKI patients with an ED discharge had a lower rate of death within 30 days than those hospitalized with AKI — 3% vs. 12%.

Not surprisingly, those with an ED discharge with AKI had a higher rate of death within 30 days than those with no AKI — 2% vs. 1%.

“It is reassuring that many patients with AKI are appropriately hospitalized; however, our study findings indicate that patients with AKI who are discharged home may still have an increased risk of poor outcomes,” explains lead researcher Rey Acedillo, MD. “This is particularly true for patients with moderate-to-severe AKI, and physicians should be vigilant in ensuring close follow-up and repeat kidney function testing for patients discharged home from the emergency department.”


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