Fresenius data show 38% of AKI patients recover kidney function

Frank Maddux

An analysis of 9,000 patients with diagnosed acute kidney injury treated at Fresenius Medical Care North America outpatient clinics indicates that about one-third of patients will recover kidney function within 90 days of starting in-center hemodialysis and one in six with persistent AKI will recover kidney function by 150 days. Overall, 38% of patients recovered kidney function within 150 days of initiating outpatient therapy, the company said in a press release.

Perspective from Deborah A. Cote, MSN, RN, CNN NE-BC

Fresenius Medical Care and other outpatient dialysis providers began treating patients diagnosed with AKI in the outpatient setting after CMS authorized payment for outpatient dialysis care in January 2017.

“This groundbreaking data holds enormous promise for developing further insights into the treatment of acute kidney injury and is the first time significant data of this type has been available anywhere,” Frank Maddux, MD, chief medical officer and executive vice president for clinical and scientific affairs at Fresenius Medical Care North America, said in the release. “This is an exciting step in our ongoing efforts to improve the treatment of people with acute kidney injury and create more personalized care so that patients are more likely to recover kidney function.”

In addition, the preliminary analysis of Fresenius data looked at other clinical measures among patients with AKI, including the type of vascular access used, ultrafiltration rates and biochemical measures in the first 90 days of outpatient dialysis therapy. The data also suggested that 20% of patients who begin outpatient in-center hemodialysis are diagnosed with AKI and 44% of those patients transition to ESRD within 150 days of starting outpatient hemodialysis. Further analysis will be needed to provide additional insights into recovery and other clinical data, Fresenius said in the press release.

Reference:

https://newsroom.fmcna.com/news-releases/1-in-6-outpatient-dialysis-patients-with-acute-kidney-injury-lasting-more-than-90-days-still-recover-kidney-function-according-to-new-data-from-fresenius-medical-care-north-america/

Perspective

Deborah A. Cote, MSN, RN, CNN NE-BC

When CMS authorized outpatient dialysis centers to provide treatment for Medicare beneficiaries with acute kidney injury (AKI), it resolved some concerns about access to care for patients. However, it presented some new challenges for dialysis providers.

All too often, AKI patients would have to travel long distances, driving past several dialysis centers, to get to a facility that could manage their care on an outpatient basis, worsening the burden of their illness. As an academic medical center treating patients with AKI on an outpatient basis, the patients were seen every treatment by the physician and had individualized plans of care. This was felt to be one of the reasons for high rates of recovery in the medical center, where we saw 42% of patient regain kidney function within 90 days.

With the ability to now dialyze AKI in any in-center hemodialysis facility alongside ESRD patients, there was much greater access to care for this population. But there was some concern that the patients would receive less individualized care, and perhaps we would see a decline in the rate of recovery. However, through education of team members and close oversight by the physicians using the same protocol as used earlier in the medical center, UVA continues to see the kidney recovery rates in our outpatient clinics: greater than 40%, or 1 in every 2.5 patients within 90 days.

As it appears now, the early results demonstrate that you can provide care for this patient population in a more economical manner, without any decline in outcomes. It would be helpful for CMS to do a claims analysis to see if these statistics are consistent for all patients with a diagnosis of acute kidney injury requiring dialysis before and after the change in regulations.

Deborah A. Cote, MSN, RN, CNN NE-BC

Administrator, Dialysis Program

University of Virginia Health System

Richmond, Va.

Editorial Advisory Board member, Nephrology News and Issues

Disclosures: Cote reports no relevant disclosures.