Primary Care Perspectives (PCPs) on Monitoring and Follow-Up after Hospitalization with AKI
Bibliographic record
Abstract
Background: AKI is associated with an increased risk of chronic kidney disease (CKD), cardiovascular disease, and mortality. KDIGO guidelines recommend at minimum rechecking creatinine and urine albumin to creatinine ratio (ACR) within 3 months of AKI. Furthermore, nephrology referral after AKI remains low despite an association with improved patient outcomes. The objective of this study was to analyze perspectives of PCPs on monitoring and follow-up of AKI following hospitalization. Methods: We surveyed Canadian PCPs using clinical vignettes about choices of laboratory monitoring and nephrology referral, following patient hospitalizations with AKI. The vignettes described various demographic and clinical factors, as well as different severities of AKI and degrees of AKI recovery. Results: 53 PCPs participated, completing at least one question. 90% of PCPs would ‘definitely’ or “probably” suggest a follow-up creatinine within 3 months of patient hospitalization with AKI, irrespective of patient variables. Participants were more likely to ‘definitely’ or ‘probably’ suggest follow up creatinine in patients with less recovery of kidney function (98%), for those receiving dialysis (98%), and for those with comorbidities (100%). 80% or more of PCPs would ‘definitely’ or “probably” suggest a follow-up measurement of urine ACR within 3 months of AKI and were more likely to recommend proteinuria monitoring in those with pre-existing CKD (90%). Less than 50% of PCPs would ‘definitely’ refer to a nephrologist following a patient’s AKI, unless they required acute dialysis during hospitalization (54%). Factors associated with increased referrals to nephrology included severe AKI (e.g. stage 3 AKI), less renal recovery, and comorbidities. Less than 25% of PCPs would ‘definitely’ or ‘probably’ seek specialist input prior to restarting a patient's ramipril, metformin, and empagliflozin post-AKI if the creatinine improved to 100 μmol/L. Conclusion: Most PCPs suggest monitoring their patient’s creatinine within 3 months of hospitalization with AKI. PCPs often would not refer to nephrology for follow up or medication advice after cases of moderate or severe AKI. Education and quality improvement initiatives warrant further testing to help PCPs optimally monitor and manage patients after a hospitalization with AKI.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".