Predictors of post-hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis

Hemodial Int. 2018 Jan;22(1):66-73. doi: 10.1111/hdi.12545. Epub 2017 Mar 13.

Abstract

Introduction: Acute kidney injury (AKI) requiring dialysis complicates 1% of all hospital admissions, and up to 30% of survivors will still require dialysis at hospital discharge. There is a paucity of data to describe the postdischarge outcomes or to guide evidence-based dialysis management of this vulnerable population.

Methods: Single-center, retrospective analysis of 100 consecutive patients with AKI who survived to hospital discharge and required outpatient dialysis. Data collection included baseline characteristics, hospitalization characteristics, and outpatient dialysis treatment variables. Primary outcome was dialysis independence 90 days after discharge.

Findings: Overall, 43% of patients recovered adequate renal function to discontinue dialysis, with the majority recovering within 30 days post discharge. Worse baseline renal function was associated with lower likelihood of renal recovery. In the first week postdischarge, patients with subsequent nonrecovery of renal function had greater net fluid removal (5.3 vs. 4.1 L, P = 0.037), higher ultrafiltration rates (6.0 vs. 4.7 mL/kg/h, P = 0.041) and more frequent intradialytic hypotension (24.6% vs. 9.3% with 3 or more episodes, P = 0.049) compared to patients that later recovered.

Discussion: A significant proportion of AKI survivors will recover renal function following discharge. Outpatient intradialytic factors may influence subsequent renal function recovery.

Keywords: Acute kidney injury; outpatient dialysis; renal function recovery.

MeSH terms

  • Acute Kidney Injury / pathology
  • Acute Kidney Injury / therapy*
  • Female
  • Hospitalization / trends*
  • Humans
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Recovery of Function / physiology*
  • Renal Dialysis / adverse effects*
  • Retrospective Studies