Worse AKI Outcomes Linked to Delayed Nephrology Referral
Delayed nephrology consultation (NC) is associated with greater mortality and increased risk of dependence at hospital discharge among critically patients with acute kidney injury (AKI), according to researchers.
Veronica Torres Costa e Silva, MD, of the University of São Paulo School of Medicine in São Paulo, Brazil, and colleagues studied 366 AKI patients, of whom 196 (53.6%) had an NC. Sixty-eight NC patients (35%) had a delayed NC and 128 (65%) had an early NC. The researchers defined delayed and early NC as occurring before and more than 48 hours after the day of AKI diagnosis, respectively.
A total of 248 patients (67.8%) died in the hospital and 115 (31.4%) required dialysis at hospital discharge. The delayed NC group had a fourfold and threefold increased odds of in-hospital mortality and dialysis dependence at hospital discharge, respectively, compared with the early NC group, the investigators reported in PLOS One (2013;8:e70482). Delayed NC patients also had significantly increased ICU lengths of stay and significantly longer mechanical ventilation support compared with the early NC group (19.0 vs. 13.5 days and 16.5 vs. 10.0 days, respectively).
Although NC patients had a greater severity of illness compared with non-NC patients, their mortality rates were similar after adjusting for propensity score.