Table 3.
Survey Responses
| Question/Responses | Neph n=24 |
PCP n=105 |
|---|---|---|
| Case 1 Summary: 40-year-old, AKI-Dialysis, no dialysis but incomplete recovery at dismissal | ||
| Question 1. What kidney function follow-up tests, if any, would you recommend for kidney function monitoring after discharge? (Select all that apply) | ||
| a. Serum creatinine | 22 (92%) | 105 (100%) |
| b. Cystatin C | 6 (25%) | 9 (9%) |
| c. Urine albumin-creatinine ratio | 13 (54%) | 35 (33%) |
| d. None/other | 8 (33%) | 10 (10%) |
| Question 2. When would you recommend follow-up laboratory monitoring of kidney function? | ||
| a. Within 14 days | 15 (63%) | 87 (83%) |
| b. Within 1-2 months | 9 (37%) | 17 (16%) |
| c. Within 6 months | 0 | 1 (1%) |
| d. Defer timing as indicated for other health care needs | 0 | 0 |
| Question 3. How would you optimize this patient’s medication regimen at discharge?19 | ||
| a. Switch atorvastatin to rosuvastatin | 0 | 2 (2%) |
| b. Monitor lithium levels and consider dose reduction (best answer) | 22 (92%) | 82 (78%) |
| c. Discontinue apixaban and initiate warfarin therapy | 1 (4%) | 4 (4%) |
| d. None of the above/unsure | 1 (4%) | 17 (16%) |
| Question 4. To what extent do you agree that this patient should be referred to a nephrologist for follow-up at the time of hospital discharge? | ||
| a. Agree | 21 (88%) | 64 (61%) |
| b. Disagree | 3 (12%) | 41 (39%) |
| Case 2 Summary: 65-year-old, AKI stage 2 with proteinuria, incomplete recovery at dismissal | ||
| Question 5. What kidney function follow-up tests, if any, would you recommend for kidney function monitoring after discharge? (Select all that apply) | ||
| a. Serum creatinine | 22 (92%) | 100 (100%) |
| b. Cystatin C | 5 (21%) | 4 (4%) |
| c. Urine albumin-creatinine ratio | 19 (79%) | 53 (51%) |
| d. None/other | 5 (21%) | 13 (12%) |
| Question 6. Based on the 2017 ACC/AHA guideline recommendations for the management of hypertension, what is an appropriate blood pressure goal for this patient?20 | ||
| a. <140/90 mm Hg | 2 (8%) | 22 (21%) |
| b. <130/80 mm Hg (best answer) | 21 (88%) | 80 (76%) |
| c. <120/90 mm Hg | 1 (4%) | 2 (2%) |
| d. <150/90 mm Hg | 0 | 0 |
| e. Unsure | 0 | 1 (1%) |
| Question 7. What additional therapy, if any, would you consider adding at outpatient follow-up, based on her kidney function at the time of discharge and past medical history? (Select all that apply)20,21,22 | ||
| a. Lisinopril (best answer) | 22 (92%) | 93 (89%) |
| b. Ezetimibe | 0 | 0 |
| c. Atorvastatin (best answer) | 8 (33%) | 28 (27%) |
| d. Furosemide | 3 (13%) | 3 (3%) |
| e. None | 1 (4%) | 6 (6%) |
| Question 8. To what extent do you agree that this patient should be referred to a nephrologist for follow-up at the time of hospital discharge? | ||
| a. Agree | 15 (63%) | 31 (30%) |
| b. Disagree | 9 (37%) | 74 (70%) |
| Case 3 Summary: 70-year-old, AKI stage 2 with proteinuria, multimorbidity, incomplete recovery at dismissal | ||
| Question 9. What action should be taken with regard to his metformin prescription at this time?23 | ||
| a. Discontinue (best answer) | 15 (63%) | 76 (72%) |
| b. Reduce the dose to metformin 500 mg twice daily | 6 (25%) | 23 (22%) |
| c. Continue at the current dose | 3 (13%) | 2 (2%) |
| d. Unsure | 0 | 4 (4%) |
| Question 10. What other work-up, if any, would you recommend in the outpatient setting given his baseline comorbidities? (Select all that apply) 24 | ||
| a. None | 2 (8%) | 9 (9%) |
| b. Rheumatologic work-up for recurrent gouty arthritis | 6 (25%) | 13 (12%) |
| c. Anemia and metabolic bone disease work-up in the setting of chronic kidney disease (best answer) | 19 (80%) | 73 (70%) |
| d. Hematologic work-up given his history of thromboembolism and bleeding | 10 (42%) | 41 (39%) |
| Question 11. To what extent do you agree that this patient should be referred to a nephrologist for follow-up at the time of hospital discharge? | ||
| a. Agree | 24 (100%) | 95 (90%) |
| b. Disagree | 0 | 10 (10%) |
Note: Data reported as n (% of the column total).
Abbreviations: ACC, American College of Cardiology; AHA, American Heart Association; AKI, acute kidney injury; Neph, nephrologist; PCP, primary care provider.