Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22572
Title: Effect of nephrology follow-up on long-term outcomes in patients with acute kidney injury: a systematic review and meta-analysis.
Authors: Ye, Nan;Xu, Ying;Bellomo, Rinaldo;Gallagher, Martin;Wang, Amanda Y
Affiliation: Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Zhejiang, China
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
The Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Australia
The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
National Key Clinical Department of Kidney Diseases, Institute of Nephrology, Zhejiang University, China
Issue Date: 4-Feb-2020
EDate: 2020-02-04
Citation: Nephrology 2020; online first: 4 February
Abstract: Acute kidney injury (AKI) is associated with poor short-term and long-term clinical outcomes. The role of nephrology follow-up in post-AKI management remains uncertain. A systematic review and meta-analysis was performed examining all randomized controlled trials and observational studies assessing the effect of nephrology follow-up on patients' clinical outcomes. The primary outcome was all-cause mortality. The secondary outcomes were renal outcomes, which were defined as a composite of requirement of permanent dialysis and recurrent AKI. Pooled analysis was performed using a random-effect model. We identified six studies (8972 patients, mean follow-up of 49 months). Five were retrospective cohort studies and one a prospective cohort study. Risk of bias was a concern with all studied. Only four studies reported primary and/or secondary outcomes and were included. Compared with patients without nephrology follow-up, patients with nephrology follow-up had significantly reduced mortality by 22% (3 studies, 3240 patients, RR, 0.78; 95% CI 0.70-0.88; I2  = 0.0%). Nephrology follow-up did not improve composite renal outcomes with high heterogeneity due to significant differences in reported renal outcomes and follow-up period (2 studies, 2537 patients, RR, 1.72; 95% CI, 0.49-6.05; I2  = 90.1%). Current evidence from observational studies is biased. It suggests long-term survival benefits with post-discharge nephrology follow-up in AKI patients. However, due to its low quality, such evidence is only hypothesis generating. Nonetheless, it provides a rationale for future randomized controlled trials of nephrology follow-up in AKI patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22572
DOI: 10.1111/nep.13698
ORCID: 0000-0001-9339-9361
0000-0002-0367-6677
0000-0002-1650-8939
PubMed URL: 32020718
Type: Journal Article
Subjects: acute kidney injury
follow-up studies
meta-analysis
nephrology
systematic review
Appears in Collections:Journal articles

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