Some AKI survivors who require hemodialysis recover kidney function
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At least one in three patients who survived AKI and required hemodialysis recovered kidney function within the first 90 days after discharge from the hospital, according to recently published data.
“Currently, there is little evidence regarding the incidence of kidney recovery in survivors of AKI requiring dialysis (AKI-D) who are discharged from the hospital to receive hemodialysis in outpatient dialysis or rehabilitation facilities,” Melissa Jordan, MD, of the department of internal medicine at the University of Kentucky, and colleagues wrote. “The main objective of this study was to longitudinally and systematically examine the incidence of kidney recovery and time to recovery in survivors of AKI-D discharged from the hospital to receive hemodialysis in outpatient dialysis or rehabilitation facilities. We also evaluated hospitalization-related clinical parameters associated with kidney recovery.”
In a single-center prospective cohort study, researchers evaluated 111 adult patients (median age was 59 years; 62% were men; 91% were white) with AKI-D at the University of Kentucky Albert B. Chandler Hospital from January 2017 to November 2019. All patients were discharged with need of outpatient hemodialysis.
The primary outcome of the study was kidney recovery. Electronic health records provided demographic, comorbid condition, acute illness and dialysis parameters.
Using discrete-time survival analysis and logistic regression, researchers established adjusted probabilities of kidney recovery at prespecified time points and measured clinical parameters correlated with recovery.
Among the 111 patients, 45 recovered kidney function within the first 30 days after discharge, 16 within 30 to 60 days and four within 60 to 90 days. Of the patients who did not recover kidney function, 49 developed kidney failure and 17 died or went to hospice. Analyses revealed patients of old age, with more comorbid conditions, with lower eGFR at baseline or who received more blood transfusions during hospitalization were less likely to recover kidney function.
“At least one-third of AKI-D survivors discharged from an acute care hospital dependent on hemodialysis recovered kidney function within the first 90 days of discharge, more commonly in the first 30 days post discharge,” Jordan and colleagues wrote. “Future studies should elucidate patient- and kidney replacement therapy-specific parameters that can risk-classify kidney recovery, with the goals of developing informative risk prediction tools, as well as identifying best clinical practices to promote kidney recovery in the inpatient and outpatient settings.”
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