Survivors of severe AKI are at increased risk of CKD progression, recurrent AKI, and mortality after hospital discharge. Although post-discharge nephrology follow-up may improve monitoring and long-term kidney outcomes, referral remains inconsistent in routine practice. This study aimed to determine the nephrology referral rate and identify factors associated with referral among survivors of severe AKI.

We conducted a retrospective cohort study at a tertiary care hospital in Thailand from January 2022 to December 2024. Hospitalized survivors of severe AKI were included, while patients with end-stage kidney disease, kidney transplantation, prior nephrology follow-up, palliative care status, or discharge for referral to another hospital were excluded. The primary outcome was nephrology referral within 3-months after discharge. Factors associated with referral were analyzed using logistic regression.

Among 710 survivors of severe AKI, 176 patients (24.8%) were referred for nephrology follow-up within 3 months after discharge. The mean age was 68.2 ± 16.0 years, and 50.7% were male. Compared with patients receiving usual care, those referred to nephrologists more frequently had diabetes mellitus, pre-existing CKD, poorer kidney function, more severe AKI, and no renal recovery at discharge. In multivariable analysis, pre-existing CKD was the strongest factor associated with nephrology referral (adjusted odds ratio [aOR] 5.76, 95% confidence interval [CI] 3.81–8.71), followed by no renal recovery at discharge (aOR 3.02, 95% CI 1.99–4.56) and AKI stage 3 requiring dialysis (aOR 2.39, 95% CI 1.08–5.26).

Nephrology referral within 3 months after severe AKI was low and appeared to be driven mainly by disease severity. Structured post-AKI referral protocols may help improve timely nephrology follow-up for high-risk survivors.