Abstract: FR-PO129

High Incidence of Transition to ESRD in Patients Discharged with Dialysis Dependent AKI: The Cleveland Clinic Experience

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Brahmbhatt, Samir A., Cleveland Clinic Foundation, Cleveland, Ohio, Beachwood, Ohio, United States
  • Armanyous, Sherif, Cleveland Clinic Foundation, Cleveland Heights, Ohio, United States
  • Lioudis, Michael, Cleveland Clinic, Solon, Ohio, United States
  • Heyka, Robert J., Cleveland Clinic Foundation, Cleveland, Ohio, Beachwood, Ohio, United States
  • Wong, Leslie P., Cleveland Clinic, Solon, Ohio, United States
  • Demirjian, Sevag, Cleveland Clinic, Solon, Ohio, United States
Background

Acute kidney injury in hospitalized patients has been reported in 20-67% of patients and is a known cause of significant morbidity and mortality. Many of them continue to require dialysis support after discharge as an out-patient, while being monitored for renal recovery. Recent approval of financial reimbursement by the Centers for Medicare & Medicaid Services (CMS) for this group of patients, labelled as Acute Kidney Injury-requiring dialysis (AKI-D) in an out-patient dialysis center, even if not declared end-stage renal disease (ESRD), will change practice patterns and shift dialysis care to chronic units. Our goal is to describe the incidence of non-recovering AKI-D and associated risk factors.

Methods

A retrospective observational cohort study of patients with AKI-D discharged from Cleveland Clinic and received outpatient dialysis at Cleveland Clinic, Cleveland, OHIO from 2010 to 2016. Data were extracted from Cleveland Clinic Acute Renal Registry.

Results

The study included 390 patients discharged from index hospitalization with AKI-D. The median age was 62 years (52, 70); 62% were male and 65% white. Two thirds of patients were critically ill requiring intensive care and most had multifactorial etiology for kidney injury with acute tubular necrosis being the clinical diagnosis in 2/3. Comorbidities included baseline chronic kidney disease (CKD) in 38%, hypertension 62%, diabetes 42%, heart failure 23%, and liver disease 20%. Baseline serum creatinine was 1.4 mg/dL (1,2); serum creatinine and urine output at dialysis initiation were 5.8 mg/dL (4.2,8), and 290 mL/day (100,660). 221 patients (56%) were transitioned to ESRD, the primary endpoint of the study. Univariate analysis showed male gender, CKD, hypertension, diabetes mellitus and heart failure to be associated with transition to ESRD.

Conclusion

In a single center study of large cohort of patients with AKI-D, the presence of baseline kidney disease, diabetes mellitus, hypertension and heart failure were associated with higher incidence of transition to ESRD.