Recurrent AKI is common among survivors of moderate-to-severe AKI and contributes to adverse kidney outcomes. Although post-AKI nephrology follow-up is recommended, its effect on recurrent AKI remains uncertain because of differences in baseline kidney risk between follow-up groups. This study evaluated whether consistent nephrologist follow-up reduces recurrent AKI compared with usual care.

We conducted a retrospective cohort study of adults discharged after KDIGO stage 2–3 AKI at Thammasat University Hospital, Thailand, between January 2018 and December 2024. Patients were categorized into consistent nephrologist follow-up and usual care groups and followed for 1 year after discharge. The primary outcome was recurrent AKI within 1 year. Secondary outcomes included major adverse kidney events (MAKE), CKD progression, readmission, and mortality. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences between groups. Weighted cumulative incidence and cause-specific hazard models were used for outcome analyses.

Among 1,267 survivors of stage 2–3 AKI, 279 (22.0%) received nephrologist follow-up and 988 (78.0%) received usual care. Before weighting, patients receiving nephrologist follow-up had higher baseline kidney risk, including greater CKD burden, more severe AKI, and poorer renal recovery at discharge. After IPTW adjustment, baseline characteristics were balanced. Nephrologist follow-up was associated with a lower risk of recurrent AKI (44.3 vs. 71.9 events per 100 person-years; HR 0.63, 95% CI 0.49–0.82; p=0.001) and readmission (HR 0.78, 95% CI 0.61–0.99; p=0.05). Composite MAKE and CKD progression were similar after IPTW adjustment, while nephrologist follow-up was associated with lower NSAID use (4.0% vs. 8.7%) and greater albuminuria monitoring (43.0% vs. 14.8%).

Nephrologist follow-up was associated with lower recurrent AKI among survivors of moderate-to-severe AKI, potentially through improved nephrotoxin avoidance and kidney surveillance. These findings support structured post-AKI care pathways.