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. 2017 Aug 7;12(8):1215-1225.
doi: 10.2215/CJN.10431016. Epub 2017 Jul 20.

Characteristics and Outcomes of Patients Discharged Home from an Emergency Department with AKI

Rey R Acedillo  1   2 , Ron Wald  3   4 , Eric McArthur  4 , Danielle Marie Nash  4 , Samuel A Silver  3 , Matthew T James  5 , Michael J Schull  4 , Edward D Siew  6   7 , Michael E Matheny  6   8   7 , Andrew A House  1 , Amit X Garg  1   2   4
Affiliations

Characteristics and Outcomes of Patients Discharged Home from an Emergency Department with AKI

Rey R Acedillo et al. Clin J Am Soc Nephrol. .

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.

Keywords: Acute Kidney Injury; Aged; Canada; Confidence Intervals; Emergency Service, Hospital; Humans; Kidney Function Tests; Ontario; Patient Discharge; Propensity Score; Retrospective Studies; Risk; creatinine; hospitalization; renal dialysis.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Study flow diagram. aPatients were excluded in order as listed. bWe selected the most recent pre-ED baseline serum creatinine measurement. cIf an individual had more than one ED visit with AKI, as defined by ED and pre-ED serum creatinine measurements, we selected the first ED visit with AKI. dIf an individual had more than one ED visit with a serum creatinine measurement, we selected the first ED visit. This group does not include patients with a subsequent ED visit with AKI (n=9549); these patients were preferentially classified as having AKI. eExcluded: improvement in AKI severity (discharged n=447, admitted n=1248); admitted to hospital (n=8117); assigned an ED diagnosis of AKI (International Classification of Diseases, Tenth Revision, code N17) (n=56). fExcluded: patients with an improvement in AKI severity (n=1695); discharged home from ED (n=6402). gExcluded: patients admitted to hospital from the ED with no AKI. hFollow-up was complete during the 30-day period. ED, emergency department.
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