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Kidney Week

Abstract: FR-PO005

Outpatient Dialysis for AKI: A Nonprofit Provider Experience

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Lacson, Eduardo K., Tufts University School of Medicine, Boston, Massachusetts, United States
  • Aweh, Gideon N., Dialysis Clinic, Inc., Nashville, Tennessee, United States
  • Manley, Harold J., Dialysis Clinic, Inc., Albany, New York, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Dad, Taimur, Tufts Medical Center, Boston, Massachusetts, United States
  • Johnson, Doug, Dialysis Clinic, Inc., Nashville, Tennessee, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States

Medicare approved reimbursement of outpatient hemodialysis (HD) for patients with acute kidney injury (AKI) in 2017. Lack of national data hinders a consensus on optimal management. We describe the experience of a multi-state non-profit dialysis provider.


We reviewed electronic medical records of all patients treated for AKI between 1/1/17 and 12/31/18 with follow-up until 3/31/19. We describe demographics, dialysis prescriptions/practices, and disposition from 187 outpatient centers with a mean (median) population of 4.4 (3.0) AKI patients treated during the two-year study period.


A total of 815 AKI patents (2017 = 318; 2018 = 497) were admitted across units with a mean age 65.1 (range: 15.7 to 97) years, 56% male, 56% Caucasian and over 98% were treated via HD catheter. Thrice weekly HD was prescribed on admission for 92% (rest <3/week) with median treatment time of 3.5 (Q1-3.0, Q3-4.0) hours and blood/dialysate flow rate of 400/600 (350/600, 400/700) ml/min, and 60% on 3K bath (36% 2K). Lab draws (e.g. creatinine, Cr) averaged weekly (lowest quartile: bi-weekly). Mean duration of AKI therapy was 47 (range: 1 to 327) days, with 45% transitioning to ESRD (averaging 61 days as AKI). Among discharges, 66% had >25% decline in Cr, indicating potential renal recovery rate of 37%. After being deemed ESRD, 22% died and 5% recovered kidney function over the study period.


Since Medicare changed reimbursement, successful treatment of stable AKI occurs in the outpatient setting. By leveraging patient-level treatment data, dialysis providers are uniquely positioned to contribute studies that may help define best practices and to benchmark clinical outcomes.