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Kidney Week

Abstract: SA-PO537

Recovery from AKI-Requiring Dialysis in Hospital Survivors Discharged to a Rehabilitation Facility

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • McAdams, Meredith, University of Kentucky, Lexington, Kentucky, United States
  • Jordan, Melissa R., University of Kentucky , Lexington, Kentucky, United States
  • Ortiz-Soriano, Victor M., University of Kentucky , Lexington, Kentucky, United States
  • Vasquez-Rios, George, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Armentrout, MS, PA-C, Brian Scott, University of Kentucky, Lexington, Kentucky, United States
  • Lima, Florence, University of Kentucky , Lexington, Kentucky, United States
  • Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
Background

Acute kidney injury-requiring dialysis (AKI-D) occurs in about 5% of hospitalized patients and is associated with poor outcome. Little is known about the incidence of AKI-D recovery following hospital discharge. We aim to examine AKI-D recovery in hospital survivors transferred to an affiliated rehabilitation facility (Select) with need of hemodialysis (HD) for AKI.

Methods

Single-center, retrospective cohort study of 42 patients who were admitted to the University of Kentucky Hospital (8/2015 to 3/2018), suffered from AKI-D and were transferred to Select with ongoing need for HD. Kidney recovery was defined as the patient being alive and no longer requiring HD support. Kidney recovery was assessed at the time of discharge from Select and from Select discharge until the end of the observation period (5/2018). Multivariable logistic regression models were performed to assess clinical characteristics associated with kidney recovery.

Results

Mean (SD) age was 61.4 (9.6) years; 61.9% were males and 90.5% whites. A total of 29 out of 42 patients (69%) recovered kidney function by the time of discharge from Select. Of these, 5 (17%) died after Select discharge (median follow-up 9.1 months). A total of 5 (12%) patients died during their stay at Select. Of the 8 (19%) patients that were discharged from Select with HD-dependent status, 3 (38%) died and only 1 recovered kidney function (median follow-up 16.5 months). The total number of hospital dialysis days was independently associated with kidney recovery at Select discharge (OR 0.81, 95% CI 0.68–0.98, p=0.027) and the number of intradialytic hypotension events during the stay at Select was associated with death or HD-dependent status at follow-up (OR 1.24, 95% CI 1.02–1.51, p=0.034).

Conclusion

At least 2 out of 3 patients transferred to a rehabilitation facility with AKI-D diagnosis recovered kidney function no longer requiring HD by the time of discharge. Dialysis-specific characteristics such as total days and intradialytic hypotension events may play a key role in the development of risk prediction models and ‘best clinical practices’ to promote kidney recovery in this susceptible population.