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Kidney Week

Abstract: PO0238

Outpatient Dialysis Prescription as Predictor and Modifiable Factor for Outcomes of Patients with Dialysis-Requiring AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Abdel-Rahman, Emaad M., UVA Health, Charlottesville, Virginia, United States
  • Casimir, Ernst, UVA Health, Charlottesville, Virginia, United States
  • Lyons, Genevieve R., UVA Health, Charlottesville, Virginia, United States
  • Ma, Jennie Z., UVA Health, Charlottesville, Virginia, United States
  • Gautam, Jitendra K., UVA Health, Charlottesville, Virginia, United States
Background

Patients with acute kidney injury requiring hemodialysis (AKI-D) have poor prognosis. Beginning January 1, 2017, End Stage Kidney Disease (ESKD) facilities were allowed to furnish dialysis services to AKI-D patients. Identifying modifiable predicators of AKI outcomes will allow better care of patients with AKI-D.

Methods

Patients with AKI-D discharged for outpatient hemodialysis (HD) to one of 11 University of Virginia dialysis units from 1/1/2017 to 12/31/2019 (n=274) were followed for up to 6 months. Multinomial logistic regression was used to estimate association between clinical and dialysis factors and outcomes: recovery (patient off dialysis), ESKD, or death at 3 and 6 months. Dialysis data from the first 28 days were analyzed.

Results

Patients were 42% female, 67% Caucasian with mean age 62.8 ± 15.4 years. Comorbidities included diabetes mellitus (42%), hypertension (78%), congestive heart failure (18%), coronary artery disease (27%), prior AKI episode (36%) with pre AKI eGFR 33.8 ± 29.1 ml/min. Median (IQR) number of dialysis sessions was 11 (6-16), lasting 3.6 ± 0.6 hours. Patients declared ESKD had more median drops in blood pressure (BP) (16) than those who recovered (9) or died (10).
At 90 days post start of outpatient HD, 45% recovered, 45% were declared ESKD and 9.9% died. Two more patients recovered, 2 patient died with one patient who was initially off HD was declared ESKD by 180 days.
Patients with more frequent BP drops had increased odds ratio (OR) of ESKD compared to patients in the lowest quartile. Adjusted odds ratios (95% CIs) for ESKD were 3.8 (1.4 – 9.7, p<0.01) and 2.7 (1.1 – 7.2, p=0.05) for patients in 3rd and 4th quartiles, respectively, adjusting for prior AKI, age, baseline eGFR, hypertension, and UF rate. The magnitude of drop in mean arterial blood pressure was not associated with ESKD or death.

Net ultrafiltration (UF) (Liters) and UF rate (ml/kg/hour) were associated with ESKD. OR (95% CIs) 1.6 (1.0 – 2.53, p=0.05) and 1.2 (1.0 – 1.3, P <0.01) respectively.

Conclusion

Optimizing dialysis prescription and close monitoring of outpatient dialysis for patients with AKI-D is crucial and may improve outcomes of these patients