Abstract: SA-PO087

Renal Recovery among Patients with AKI Who Require Outpatient Dialysis: Impact of ESRD Certification

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
  • Yin, Maggie, University of Michigan, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • He, Kevin, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Shahinian, Vahakn B., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

AKI patients requiring outpatient dialysis are a vulnerable and growing population. We examined factors associated with ESRD certification and its impact on subsequent renal recovery.

Methods

Using a national Medicare 5% sample from 2004-2014, we identified a cohort of hospitalized patients with AKI-D who survived to discharge and required outpatient dialysis (n=5861). We compared patient characteristics between those declared ESRD (CMS Form 2728) within 10 days of hospital discharge (ESRD group) to those who were not (AKI group). We also examined renal recovery (dialysis independence for >30 days) at 90 and 365 days post-discharge, and time trends.

Results

Among the AKI-D outpatient cohort, 76% were declared ESRD while 24% remained AKI. There were no differences between the ESRD and AKI groups in sex or age distribution. Blacks were more likely to be ESRD than whites. The ESRD group had greater proportions of DM, CHF and pre-existing CKD. By 90 days 9.3% of ESRD and 41.2% of AKI patients recovered renal function. At 365 days these rates rose to 15.5% and 44.9%. In a multivariate model, lower odds of 90 day renal recovery were associated with ESRD declaration (OR 0.14, 0.12-0.17), CKD, CHF and black race. During the study period, a decreasing proportion of AKI-D patients were declared ESRD; 90 day recovery rates also decreased slightly, while 365 day rates remained stable (Figure). A significant proportion of AKI-D patients recovered renal function after hospital discharge, including those declared ESRD. After adjusting for clinical factors, ESRD certification remained the strongest independent predictor of renal non-recovery.

Conclusion

Further study is needed to determine the impact of ESRD versus AKI dialysis protocols on renal recovery.

Post-hospitalization outcomes for Medicare AKI-D patients, 2004-2014

Funding

  • NIDDK Support