Outpatient Dialysis for Patients with AKI

Heung, Michael; Faubel, Sarah; Watnick, Suzanne; Cruz, Dinna N.; Koyner, Jay L.; Mour, Girish; Liu, Kathleen D.; Cerdá, Jorge; Okusa, Mark D.; Lukaszewski, Mark; Vijayan, Anitha

doi:10.2215/cjn.02290215

Cited by 26 publications

(24 citation statements)

References 27 publications

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“…The "Trade Bill" (passed on June 29, 2015 and effective January 1, 2017) allows Medicare to reimburse for dialysis care provided to AKI outpatients at ESRD facilities, a reversal from the previous position. 11 As such, it is likely that more AKI patients will be entering a realm which is most accustomed to chronic dialysis patients where the prospect of recovery of renal function is remote, and clinician focus is on achieving effective dialysis and establishing dry weight. For AKI patients, clinicians will need to be vigilant in monitoring for renal function recovery and in avoiding complications such as intradialytic hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies examining predictors of renal recovery have focused on either nonmodifiable factors or inpatient treatment factors . As a result, there is a lack of evidence‐basis and no guidelines for how to optimize outpatient management of AKI patients to best promote renal recovery and dialysis‐independence …”

Section: Introductionmentioning

confidence: 99%

“…1,9,10 As a result, there is a lack of evidence-basis and no guidelines for how to optimize outpatient management of AKI patients to best promote renal recovery and dialysisindependence. 4,11 Recent studies have provided important insight into current care practices for the high-risk population of patients with AKI requiring dialysis at hospital discharge. 12,13 These studies have helped characterize recovery patterns and identified patient factors that may be predictive of renal recovery.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of post‐hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis

Pajewski

Gipson

Heung

2017

Hemodialysis International

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Introduction: Acute kidney injury (AKI) requiring dialysis complicates 1% of all hospital admissions, and up to 30% of survivors will still require dialysis at hospital discharge. There is a paucity of data to describe the postdischarge outcomes or to guide evidence-based dialysis management of this vulnerable population.Methods: Single-center, retrospective analysis of 100 consecutive patients with AKI who survived to hospital discharge and required outpatient dialysis. Data collection included baseline characteristics, hospitalization characteristics, and outpatient dialysis treatment variables. Primary outcome was dialysis independence 90 days after discharge.Findings: Overall, 43% of patients recovered adequate renal function to discontinue dialysis, with the majority recovering within 30 days post discharge. Worse baseline renal function was associated with lower likelihood of renal recovery. In the first week postdischarge, patients with subsequent nonrecovery of renal function had greater net fluid removal (5.3 vs. 4.1 L, P 5 0.037), higher ultrafiltration rates (6.0 vs. 4.7 mL/kg/h, P 5 0.041) and more frequent intradialytic hypotension (24.6% vs. 9.3% with 3 or more episodes, P 5 0.049) compared to patients that later recovered.Discussion: A significant proportion of AKI survivors will recover renal function following discharge. Outpatient intradialytic factors may influence subsequent renal function recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of post‐hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis

Pajewski

Gipson

Heung

2017

Hemodialysis International

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“…Mortality rate among these patients with AKI-D remains high. While some reports showed the in-hospital mortality rate for patients with AKI-D to range between 28 and 70% [1,2], other reports estimated that approximately 10-32% of AKI patients will survive to require dialysis at the time of their discharge [2,6,8]. …”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes and Associated Risk Factors of Post-Hospitalization Dialysis-Dependent Acute Kidney Injury Patients

Rathore

Chopra

Jennie

et al. 2017

Nephron

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Background/Aims: Acute kidney injury requiring dialysis (AKI-D) is associated with poor outcomes. Centers for Medicare and Medicaid Services have reversed their clarification allowing AKI-D patients to be dialyzed at outpatient dialysis units. Data assessing long-term outcomes of AKI-D patients and their predictors is needed to adopt guidelines to ensure adequate management. We assessed long-term outcomes and associated risk factors of AKI-D patients who survived 90 days post-hemodialysis (HD) initiation. Methods: AKI-D patients surviving hospitalization and dialyzed at a specialized outpatient AKI dialysis unit between April 11, 2012 and December 25, 2013 were prospectively followed. Long-term outcomes of AKI-D patients were obtained by a single provider through a telephone survey, and factors affecting their outcomes were statistically analyzed. Results: Ninety-one out of 108 patients were reached for telephone survey. At baseline (90 days post-HD initiation), 52/91 patients were declared end-stage renal disease (ESRD; group 1) and 39/91 were dialysis-independent (group 2). At the end of an average follow up period of 859.7 days, 32/91 (35.2%) were dialysis-independent (3/52 from group 1 and 29/39 from group 2), with 28/91 dead (25/52 from group 1 and 3/39 from group 2). After adjusting for demographics and comorbidities, baseline renal function, prior AKI, ESRD, and requirement for continuous renal replacement therapy were associated with poor outcomes. Conclusions: Sustaining long-term dialysis independence in AKI-D patients is significant. Baseline renal function, prior AKI, and hemodynamic changes during hospitalization are predictors of long-term outcomes. Meticulous follow up of AKI-D patients in the outpatient dialysis facilities in their first 90 days post-HD initiation is crucial.

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“…These patients may require a different approach to volume management, avoiding aggressive ultrafiltration to limit hypotensive episodes that may further exacerbate kidney injury. 12,13 As time progresses, and the chance of renal recovery wanes, patients will need education regarding modality, transplant, and access. At some point, patients with AKI who remain dialysis dependent may need a change in status to ESRD.…”

mentioning

confidence: 99%

The AKI Clinic for Fragile Patients

Yee

Campbell

2017

Advances in Chronic Kidney Disease

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The AKI Clinic for Fragile Patients T he recent terrorist attack in Manchester, England, at a pop "musical" concert 1 represents a somber reminder of the London Blitz-the "lightning war"-prosecuted by Hitler against Great Britain during World War II. The dome of the church on the cover illustration, provided by Guest Editor, Charuhas Thakar, represents the hope of the Londoners who survived the protracted bombing that lasted 9 months, and our own hope that an effective resolution to the abject, lawless acts of violence by fanatical and radical terrorists comes soon. Nephrologists are well acquainted with the physical repercussions of bombing. During the Blitz, muscle "crush" injuries from entrapment under the rubble of destroyed buildings led to oliguric kidney failure, eloquently described by Bywaters and Beall. 2 Without the extant technologies of kidney replacement that are commonplace in contemporary nephrology, those who did not experience rapid recovery of kidney function died a uremic death. From the clinical observations of the Blitzkrieg victims, Bywaters and Beall formulated the construct of myoglobin-induced acute kidney injury (AKI), Bywaters and colleagues subsequently developed 2 animal models of rhabdomyolysis-induced AKI that still serve as touchstones for all clinician scientists. One involved injection of crystalline myoglobin 3 and the other a controlled muscular crush injury. 4 Indeed, the scientific inquiry into pigmentary nephropathy via the subsequently developed rodent model of glycerol-induced rhabdomyolysis greatly advanced the knowledge base of AKI. These advances were followed by more comprehensive analyses of rhabdomyolysis-induced AKI and have elucidated that nearly all mechanisms of AKI are at play, including ischemic, toxic, cytokine mediated, among others. Despite advances in our understanding of AKI pathophysiology, we remain naïve in many areas, including even

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Outpatient Dialysis for Patients with AKI

Cited by 26 publications

References 27 publications

Predictors of post‐hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis

Predictors of post‐hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis

Long-Term Outcomes and Associated Risk Factors of Post-Hospitalization Dialysis-Dependent Acute Kidney Injury Patients

The AKI Clinic for Fragile Patients

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