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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

Authors

  • 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
Background

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.

Methods

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.

Results

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.

Conclusion

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.