Acute Kidney Injury Episodes Led to Significant Impacts on Physical, Emotional Health

In survey of patients who have experienced acute kidney injury (AKI), a vast majority of respondents reported that AKI episodes have been very or extremely impactful on their physical and emotional health, showing the significant ways that AKI impacts patients’ health-related quality of life (HRQOL).

The retrospective cross-sectional survey analysis, published in Kidney360, helped to describe the range of how AKIs influence aspects of HRQOL, including physical or functional, emotional, social, and health care communication. The study also offered evidence into the potential differences in impacts of AKI across genders and age groups.

“These findings are a critical step forward in our understanding of the range of AKI experiences/consequences….Health care professionals should be more proactive and informative in their patient communication about AKI and in their post-AKI follow-up, and more effective means of patient education and communication regarding AKI are needed to address patient concerns,” the investigators wrote.

AKIs are estimated to occur in 18 of every 1000 people in the United States and affect about 60% of all patients admitted to intensive care units. About 20% of patients with AKI are readmitted to hospitals within 30 days after their first hospitalization and carry an elevated risk of acute myocardial infarction and congestive heart failure. The development of newly onset chronic kidney disease (CKD) or worsening of pre-existing CKD occurs in about 30% of patients who survive an AKI episode. It is also associated with an increased risk of kidney failure progression. Additionally, people who survive an AKI episode tend to have a poorer quality of life and consume a greater proportion of health care resources compared with those who have not experienced one.

Past research has not identified which factors of AKI experience affect HRQOL elements the most, and the majority of studies have been small and single-centered.

Between October 14, 2020, and October 26, 2021, the investigators collected survey responses from adult survivors of AKI episodes who were members of the American Association of Kidney Patients (AAKP). Of the 23,582 people who were invited to participate, 124 survivors completed the survey. The survey contained 3 categories, including sociodemographic information; impacts of AKI on physical, emotional, and social aspects; and perceptions about interactions with health care providers.

The mean (SD) age of the cohort during their first AKI episode was 53 (19) years, with 78% of the cohort falling between the ages of 22 and 65 years at the time of their first AKI episode. The mean (SD) age of the cohort at the time of the survey was 62 (13) years. Overall, 77% of the participants were White and 55% had at least a bachelor’s degree.

A large majority of the participants reported that experiencing an AKI episode was either “very” or “extremely” impactful on their physical and emotional health (84%; 95% CI, 76%-90%), and a significant portion reported not feeling physically well (48%) or felt weak or tired (36%). Some participants reported feeling unable to do daily activities (28%), feeling anxious or stressed (36%), feeling unable to do fun or recreational activities (44%), having trouble sleeping (42%), feeling unwell emotionally (32%), or feeling down or depressed (32%).

Between 15% and 25% of the participants had issues with coordination of care (20%) and with receiving information about AKI (22%), had problems with dietary restrictions (21%), and had concerns about medical costs (16%). Additionally, 67% (95% CI, 57%-76%) of respondents reported being “very” or “extremely” concerned about the effects of an AKI episode on their families, with several participants responded that they worried about feeling rejected or misunderstood by family, feeling like a burden to family members, not being able to support their family, and losing their independence.

The study had several limitations, including that the sample was derived from a list of AAKP members, suggested that they may be more knowledgeable about AKIs compared with the general population with AKI. The investigators listed the primarily White population, the retrospective nature of the analysis, and the lack of evaluation of comorbidities and acute illnesses as other limitations.

“Future research should incorporate more comprehensive HRQOL measures and health care professionals should consider providing more information in their patient communication about AKI and follow-up,” the investigators suggested.

Reference

Switzer G, Puttarajappa C, Kane-Gill SL, et al. Patient-reported experiences after acute kidney injury across multiple health-related quality-of-life domains. Kidney360. 2021;2(11):2641-7650. doi:10.34067/KID.0002782021