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

Abstract

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.

International consensus definitions of clinical trial outcomes for kidney failure: 2020

“…Its role was to review the literature of consensus definitions in other domains 20,21,23,24 and develop a scope-of-work document pertinent to nephrology and kidney failure. Table 1 19,[25][26][27] describes the complete process.…”

Effect of renal replacement therapy modalities on renal recovery and mortality for acute kidney injury: A PRISMA‐compliant systematic review and meta‐analysis

“…Results regarding to comparison in renal recovery, in‐hospital mortality, and in‐ICU mortality between AKI patients given CRRT and those given SLED were corresponding to previous studies 4,30 published in recent years. According to previous studies, worse baseline renal function and more frequent intradialytic hypotension were associated with lower likelihood of renal recovery 31,32 . Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality 33 .…”

“…According to previous studies, worse baseline renal function and more frequent intradialytic hypotension were associated with lower likelihood of renal recovery. 31,32 Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. 33 Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality.…”

Quality of Care for Acute Kidney Disease: Current Knowledge Gaps and Future Directions

“…42 In AKI-D, IDH may exacerbate ischemic kidney injury and decrease the chances of recovery. 43 Two separate retrospective studies found that higher ultrafiltration rates and more frequent IDH were associated with a lower likelihood of recovery in outpatients with AKI-D. 43,44 At a minimum, patients with AKI-D should have a regular (weekly) reassessment of target weight and fluid removal goals. In non-anuric patients, diuretics may be helpful to limit interdialytic weight gain and decrease ultrafiltration rates.…”

“…Intradialytic hypotension is associated with adverse outcomes and may decrease the likelihood of kidney function recovery in patients with AKI-D. 43,44 Emphasizing the importance of limiting interdialytic weight gain is essential, as is the careful adjustment of antihypertensive medications.…”