Rey R Acedillo1,2, Ron Wald3,4, Eric McArthur4, Danielle Marie Nash4, Samuel A Silver3, Matthew T James5, Michael J Schull4, Edward D Siew6,7, Michael E Matheny6,7,8, Andrew A House9, Amit X Garg9,2,4. 1. Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; rey.acedillo@gmail.com. 2. Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. 3. Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, Ontario, Canada. 5. Division of Nephrology, Department of Medicine, Foothills Hospital, Calgary, Alberta, Canada. 6. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for AKI Research. 7. Tennessee Valley Health Services Veterans Affairs, Nashville, Tennessee. 8. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; and. 9. Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Patients discharged home from an emergency department with AKI are not well described. This study describes their characteristics and outcomes and compares these outcomes to two referent groups. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a population-based retrospective cohort study in Ontario, Canada from 2003 to 2012 of 6346 patients aged ≥40 years who were discharged from the emergency department with AKI (defined using serum creatinine values). We analyzed the risk of all-cause mortality, receipt of acute dialysis, and hospitalization within 30 days after discharge. We used propensity score methods to compare all-cause mortality to two referent groups. We matched 4379 discharged patients to 4379 patients who were hospitalized from the emergency department with similar AKI stage. We also matched 6188 discharged patients to 6188 patients who were discharged home from the emergency department with no AKI. RESULTS: There were 6346 emergency department discharges with AKI. The mean age was 69 years and 6012 (95%) had stage 1, 290 (5%) had stage 2, and 44 (0.7%) had stage 3 AKI. Within 30 days, 149 (2%) (AKI stage 1: 127 [2%]; stage 2: 15 [5%]; stage 3: seven [16%]) died, 22 (0.3%) received acute dialysis, and 1032 (16%) were hospitalized. An emergency department discharge versus hospitalization with AKI was associated with lower mortality (3% versus 12%; relative risk, 0.3; 95% confidence interval, 0.2 to 0.3). An emergency department discharge with AKI versus no AKI was associated with higher mortality (2% versus 1%; relative risk, 1.6; 95% confidence interval, 1.2 to 2.0). CONCLUSIONS: Patients discharged home from the emergency department with AKI are at risk of poor 30-day outcomes. A better understanding of care in this at-risk population is warranted, as are testing strategies to improve care.
BACKGROUND AND OBJECTIVES:Patients discharged home from an emergency department with AKI are not well described. This study describes their characteristics and outcomes and compares these outcomes to two referent groups. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a population-based retrospective cohort study in Ontario, Canada from 2003 to 2012 of 6346 patients aged ≥40 years who were discharged from the emergency department with AKI (defined using serum creatinine values). We analyzed the risk of all-cause mortality, receipt of acute dialysis, and hospitalization within 30 days after discharge. We used propensity score methods to compare all-cause mortality to two referent groups. We matched 4379 discharged patients to 4379 patients who were hospitalized from the emergency department with similar AKI stage. We also matched 6188 discharged patients to 6188 patients who were discharged home from the emergency department with no AKI. RESULTS: There were 6346 emergency department discharges with AKI. The mean age was 69 years and 6012 (95%) had stage 1, 290 (5%) had stage 2, and 44 (0.7%) had stage 3 AKI. Within 30 days, 149 (2%) (AKI stage 1: 127 [2%]; stage 2: 15 [5%]; stage 3: seven [16%]) died, 22 (0.3%) received acute dialysis, and 1032 (16%) were hospitalized. An emergency department discharge versus hospitalization with AKI was associated with lower mortality (3% versus 12%; relative risk, 0.3; 95% confidence interval, 0.2 to 0.3). An emergency department discharge with AKI versus no AKI was associated with higher mortality (2% versus 1%; relative risk, 1.6; 95% confidence interval, 1.2 to 2.0). CONCLUSIONS:Patients discharged home from the emergency department with AKI are at risk of poor 30-day outcomes. A better understanding of care in this at-risk population is warranted, as are testing strategies to improve care.
Authors: Saswata Deb; Peter C Austin; Jack V Tu; Dennis T Ko; C David Mazer; Alex Kiss; Stephen E Fremes Journal: Can J Cardiol Date: 2015-05-23 Impact factor: 5.223
Authors: Glenn M Chertow; Elisabeth Burdick; Melissa Honour; Joseph V Bonventre; David W Bates Journal: J Am Soc Nephrol Date: 2005-09-21 Impact factor: 10.121
Authors: Bnar Talabani; Soha Zouwail; Rhodri D Pyart; Soma Meran; Stephen G Riley; Aled O Phillips Journal: Nephrology (Carlton) Date: 2014-05 Impact factor: 2.506
Authors: Paul M Palevsky; Jane Hongyuan Zhang; Theresa Z O'Connor; Glenn M Chertow; Susan T Crowley; Devasmita Choudhury; Kevin Finkel; John A Kellum; Emil Paganini; Roland M H Schein; Mark W Smith; Kathleen M Swanson; B Taylor Thompson; Anitha Vijayan; Suzanne Watnick; Robert A Star; Peter Peduzzi Journal: N Engl J Med Date: 2008-05-20 Impact factor: 91.245
Authors: Orfeas Liangos; Ron Wald; John W O'Bell; Lorilyn Price; Brian J Pereira; Bertrand L Jaber Journal: Clin J Am Soc Nephrol Date: 2005-10-26 Impact factor: 8.237
Authors: Douglas S Lee; Michael J Schull; David A Alter; Peter C Austin; Andreas Laupacis; Alice Chong; Jack V Tu; Thérèse A Stukel Journal: Circ Heart Fail Date: 2010-01-27 Impact factor: 8.790
Authors: Samuel A Silver; Mitra K Nadim; Donal J O'Donoghue; Francis P Wilson; John A Kellum; Ravindra L Mehta; Claudio Ronco; Kianoush Kashani; Mitchell H Rosner; Michael Haase; Andrew J P Lewington Journal: Am J Med Date: 2019-12-10 Impact factor: 4.965
Authors: Khai Gene Leong; Elyce Ozols; John Kanellis; David J Nikolic-Paterson; Frank Y Ma Journal: Int J Mol Sci Date: 2020-05-22 Impact factor: 5.923
Authors: Erasto Sylvanus; Hendry R Sawe; Biita Muhanuzi; Elly Mulesi; Juma A Mfinanga; Ellen J Weber; Said Kilindimo Journal: BMC Emerg Med Date: 2019-01-22