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

Abstract

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.

Acute Kidney Injury In Turkey: Epidemiological Characteristics, Etiology, Clinical Course And Prognosis

“…Iram et al [3] reported that 4.35% of their AKI patients died and CKD developed in 28.69%. There are similar reports about this subject in the literature [4][5][6].…”

Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

“…A recent study showed that patients with eGFR ≥ 30 mL/min/1.73 m 2 had a significantly higher likelihood of kidney function recovery, even after adjustment for intensive care unit (ICU) initiation, catheter access, sepsis/postoperative etiology of AKI, acute tubular necrosis and heart failure (HR, 5.86, p < 0.001) [21]. Researchers at the university of Virginia evaluated outcomes of patients with AKI-D following their hospital discharge, and showed that patients with baseline eGFR <45 mL/min are 88% less likely to achieve dialysisindependence, both short-term [7] and long-term [25]. Similar studies further highlighted the effect of baseline renal function on kidney function recovery [21,24,26].…”

Reflections on the KDIGO Definition of Acute Kidney Injury and Its Integration in the Concept of Acute Diseases and Disorders and Chronic Kidney Diseases

“…Second, most clinicians may find it difficult to change the definition AKI into AKD after 7 days, when confronted with patients who need dialysis beyond 1 week, or even up to 3 months after the start of AKI [96][97][98].…”