Kidney recovery in patients discharged to an acute rehabilitation facility with acute kidney injury requiring hemodialysis

McAdams, Meredith; Ortiz-Soriano, Victor; Jordan, Melissa; Armentrout, Brian; Vasquez-Rios, George; Lima, Florence; Sawaya, B. Peter; Neyra, Javier A.

doi:10.5414/cn109743

Cited by 15 publications

(29 citation statements)

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“…This may have been mediated by IDH which was also more common in that treatment arm. Beyond what occurs during critical illness, further episodes of IDH during the recovery period may also hamper kidney recovery [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Beaubien‐Souligny

Yang

Burns

et al. 2021

Ann. Intensive Care

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Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

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Section: Discussionmentioning

confidence: 99%

Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Beaubien‐Souligny

Yang

Burns

et al. 2021

Ann. Intensive Care

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“…While several prior singlecenter studies have reported kidney recovery rates between 42-66%, all of these evaluated outcomes in patients dialyzing in either a long-term acute care facility or hospital-based dialysis unit. [5][6][7] The study similarly showed a higher incidence of kidney recovery in patients receiving HD care in rehabilitation facilities versus outpatient HD units. While this information was not reported as part of the study, it is conceivable that due to the nature of the setting, those patients in rehabilitation facilities or in-hospital J o u r n a l P r e -p r o o f units may have received closer monitoring for return of kidney function, including more frequent laboratory evaluation, more frequent kidney provider encounters and lower nurse to patient staffing ratios than their counterparts in community HD units.…”

mentioning

confidence: 87%

Outpatient Hemodialysis for Acute Kidney Injury Post-Medicare Coverage: How Are We Doing?

Struthers

Bieber

2021

Kidney Medicine

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…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.…”

Section: Weight Assessmentmentioning

confidence: 99%

“…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.…”

Section: Hypotensionmentioning

confidence: 99%

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

Mehta

Rosner

Koyner

et al. 2020

Kidney International Reports

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Acute kidney injury (AKI) and acute kidney disease (AKD) are common complications in hospitalized patients and are associated with adverse outcomes. Although consensus guidelines have improved the care of patients with AKI and AKD, guidance regarding quality metrics in the care of patients after an episode of AKI or AKD is limited. For example, few patients receive follow-up laboratory testing of kidney function or post-AKI or AKD care through nephrology or other providers. Recently, the Acute Disease Quality Initiative developed a consensus statement regarding quality improvement goals for patients with AKI or AKD specifically highlighting efforts regarding quality and safety of care after hospital discharge after an episode of AKI or AKD. The goal is to use these measures to identify opportunities for improvement that will positively affect outcomes. We recommend that health care systems quantitate the proportion of patients who need and actually receive follow-up care after the index AKI or AKD hospitalization. The intensity and appropriateness of follow-up care should depend on patient characteristics, severity, duration, and course of AKI of AKD, and should evolve as evidence-based guidelines emerge. Quality indicators for discharged patients with dialysis requiring AKI or AKD should be distinct from end-stage renal disease measures. Besides, there should be specific quality indicators for those still requiring dialysis in the outpatient setting after AKI or AKD. Given the limited preexisting data guiding the care of patients after an episode of AKI or AKD, there is ample opportunity to establish quality measures and potentially improve patient care and outcomes. This review will provide specific evidence-based and expert opinionbased guidance for the care of patients with AKI or AKD after hospital discharge.

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Kidney recovery in patients discharged to an acute rehabilitation facility with acute kidney injury requiring hemodialysis

Cited by 15 publications

References 0 publications

Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Outpatient Hemodialysis for Acute Kidney Injury Post-Medicare Coverage: How Are We Doing?

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

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