Association of an AKI Follow-Up Clinic with Patient Outcomes and Care Processes: A Propensity-Matched Cohort Study
Bibliographic record
Abstract
Background: Survivors of AKI are at higher risk of chronic kidney disease and death, but few patients see a nephrologist following hospital discharge. Our objectives were to determine whether an AKI Follow-up Clinic is associated with changes in care processes and a reduction in major adverse kidney events in comparison to survivors of AKI who received usual care. Methods: We identified all patients ≥ 18 years of age who survived a hospitalization with AKI from February 1, 2013 to September 30, 2017 and visited our hospital's AKI Follow-up Clinic within 6-months of hospital discharge. We used propensity scores to match each patient to 4 patients in the region who received usual care. We randomly assigned the control group index dates to ensure these patients were alive and could have received follow-up care. The primary outcome was time to a major adverse kidney event, defined as death, chronic dialysis, or CKD (newly sustained eGFR < 60mL/min/1.73m2 or a sustained decrease in eGFR ≥ 25% from baseline). We also measured processes of care after AKI, which included nephrologist visits and serum creatinine/proteinuria testing. Results: We matched 170 AKI Follow-up Clinic patients to 680 patients who received usual care. Approximately 75% in each group had KDIGO stage 2-3 AKI, with similar mean eGFR [SD] at baseline (64.6 [25.1] versus 64.2 [27] mL/min/1.73m2) and hospital discharge (49.6 [24.6] versus 49.0 [28.1] mL/min/1.73m2). The AKI Follow-up Clinic group had more nephrology visits per patient-year (1.4 [3.1] versus 0.7 [1.5]), with a greater proportion completing serum creatinine (94% versus 84%) and proteinuria (49% versus 25%) tests within 90-days of hospital discharge. Care in the AKI Follow-up Clinic was not associated with time to a major adverse kidney event (HR=0.90, 95% CI 0.72-1.13), but it was associated with a decreased risk of death (HR=0.55, 95% CI 0.37-0.82). Conclusions: The AKI Follow-up Clinic was not associated with a decreased risk of major adverse kidney events, possibly due to an increased risk of CKD from more serum creatinine testing. The association with reduced mortality warrants confirmation in randomized controlled trials. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".