Abstract

Objectives Hospitalisation with acute kidney injury (AKI) is associated with short-term and long-term adverse events, but patient and caregiver experiences with AKI are not well described. We sought to better understand patient and caregiver perspectives after a hospitalisation with AKI to inform discharge strategies that may improve outcomes for this high-risk population.

Design Qualitative study with semistructured interviews.

Setting Tertiary care hospital in Toronto, Ontario, Canada.

Participants Adult patients (n=15) who survived a hospitalisation with Kidney Disease Improving Global Outcomes stage 2 or 3 AKI from May to December 2016. We also interviewed five patient caregivers. We required patients to have no previous evidence of severe chronic kidney disease (ie, prior receipt of dialysis, previous kidney transplantation or pre-existing estimated glomerular filtration rate (eGFR) under 30 mL/min/1.73 m2).

Results We identified three over-arching themes: (1) prioritisation of conditions other than AKI, reflected by the importance placed on other comorbidities and the omission of AKI as part of the ongoing medical history; (2) variability in comprehension of the significance of AKI, represented by minimal knowledge of the causes and symptoms associated with AKI, along with misinformation on the kidneys’ ability to self-repair; and (3) anxiety from discharge planning and competing health demands, illustrated by complicated discharge plans involving multiple specialist appointments.

Conclusions Patients and caregivers view AKI as a short-term and reversible condition, giving it little thought during the postdischarge period. As a result, reliance on patients and caregivers to report an episode of AKI to their outpatient physicians is unlikely to be successful. Patient-centred tools and decision aids are needed to bridge the gap between a hospitalisation with AKI and the safe transition to the outpatient setting.

Document Type

Article

Publication Date

6-15-2018

Notes/Citation Information

Published in BMJ Open, v. 8, issue 6, e021418, p.1-8.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Digital Object Identifier (DOI)

https://doi.org/10.1136/bmjopen-2017-021418

Funding Information

SAS was supported by a Kidney Research Scientist Core Education and National Training Program Post-Doctoral Fellowship (co-funded by the Kidney Foundation of Canada, Canadian Society of Nephrology and Canadian Institutes of Health Research). JAN was supported by the Ben J Lipps Research Fellowship Program of the American Society of Nephrology Foundation for Kidney Research. LJ was supported by the St. Michael’s Hospital Volunteer Association Chair in Nursing Research and a Ministry of Health and Long-Term Care Early Nursing Research Award.

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