Study: Brief dialysis may be best approach for some patients with AKI
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Key takeaways:
- Of patients with AKI who recovered, dialysis frequency was weaned in 18%.
- In the same cohort, session duration weaned in 9% and 72% discontinued dialysis.
Brief dialysis may lead to better outcomes for patients with AKI on outpatient hemodialysis, according to recently published data from researchers at the University of California, San Francisco.
“Dialysis requiring AKI now accounts for more than 15% of outpatient hemodialysis initiations, and more than 30% may have the potential to recover,” Ian E. McCoy, MD, of the University of California, San Francisco division of nephrology, and colleagues wrote in the Journal of the American Society of Nephrology. “However, little is known about how these patients are managed.”
Patients who have AKI requiring outpatient dialysis, and who often have the capacity to recover, typically receive the same treatment as those with end-stage kidney disease caused by long-standing hypertension or diabetes, and who often must remain on lifelong dialysis or receive a new kidney, the researchers wrote. However, prolonged dialysis for patients with AKI may create unnecessary risks of heart disease, infection, organ damage and death, they noted.
The study monitored 1,754 patients with AKI and 6,197 with ESKD at 70 medium-sized not-for-profit outpatient dialysis centers between 2017 and 2022. Despite lab tests suggesting that patients with AKI needed less dialysis, both groups received similar treatment. Each group started dialysis three times per week, and most patients in both groups were not tested for kidney function in the first month of treatment. Researchers compared initial dialysis prescriptions, frequency of blood work and timed urine collection in the first 30 days for patients with AKI and those with incident ESKD.
Of the patients with AKI, 10% died during the study. The deaths were likely from conditions that prompted dialysis, the authors noted.
Overall, 725 patients with AKI recovered during follow-up. There were no changes to either prescribed dialysis frequency or session duration for 70% of all patients with AKI. Of those who recovered, dialysis frequency was weaned in 18% and session duration weaned in 9%, according to the researchers. Meanwhile, 72% discontinued dialysis without any change from their initial prescription. Among patients in whom dialysis frequency was weaned, 7% had frequency reverted to the initial level.
One significant concern highlighted by the researchers is the worst-case scenario of a patient who may have recovered sufficient kidney function but remains on dialysis. Repeated treatment, potentially unnecessary for those with recovery potential, could lead to drops in blood pressure, causing further damage to vulnerable kidneys. This damage might drive kidney function below the threshold necessary for successful weaning, according to the release.
“More research is needed on safe weaning strategies,” McCoy said in a press release. “If a patient is weaned off too quickly, they could become short of breath, or they could develop electrolyte abnormalities that can increase the risk of dangerous heart rhythms.”
The findings highlight several “opportunities to improve the care of patients with AKI who require dialysis after discharge from the hospital,” the researchers wrote in the study.
Reference:
Brief dialysis may be best for some kidney patients. https://www.ucsf.edu/news/2023/09/426271/brief-dialysis-may-be-best-some-kidney-patients. Published Sept. 28, 2023. Accessed Oct. 24, 2023.
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