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Kidney Week

Abstract: SA-OR09

Dialysis Weaning Is Uncommon in the Treatment of Outpatient AKI Requiring Dialysis (AKI-D)

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • McCoy, Ian Ellis, University of California San Francisco, San Francisco, California, United States
  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

Recovery from dialysis-requiring acute kidney injury (AKI-D) often occurs after discharge from the hospital, following treatment in outpatient hemodialysis units. The dialysis weaning strategies employed during outpatient recovery (weaning dialysis frequency, weaning dialysis session duration, or proceeding directly to a trial of complete dialysis cessation) have not been described.

Methods

We examined outpatient dialysis orders for a cohort of 1,754 AKI-D patients initiating in-center hemodialysis between 7/1/2017 and 6/30/2022 across 67 different dialysis units operated by a medium-sized, not-for-profit dialysis provider. We followed patients for 3 months after first outpatient hemodialysis treatment (or until recovery defined as discharge from dialysis with no readmission or death within the next two weeks). During follow-up, we assessed changes in prescribed hemodialysis frequency and session duration.

Results

95% of AKI-D patients were initially ordered for ≥3x/week dialysis frequency. At 3 months after first outpatient hemodialysis treatment, 41% had recovered, 49% continued to receive dialysis, and 10% had died. During follow-up, 70% had no changes to either prescribed dialysis frequency or session duration. Among those who recovered, dialysis frequency was weaned in 18% and dialysis session duration was weaned in 9%; all others discontinued dialysis without a change from their initial prescription. Among those who remained on dialysis or died, frequency was weaned in 11%.

Conclusion

In this contemporary cohort of patients with AKI-D in outpatient hemodialysis centers, dialysis weaning was uncommon. That many patients were able to transition directly from thrice-weekly treatment to no hemodialysis suggests there may be substantial opportunity to wean dialysis more often (e.g., to twice weekly treatment), likely resulting in cost savings and quality of life improvement.

Outpatient dialysis prescriptions for AKI-D patients, stratified by outcomes 3 months after first outpatient dialysis
 RecoveredContinued receiving dialysisDied without recovery
Sample size (N)725862167
No prescription change during follow-up522 (72%)569 (66%)133 (80%)
Decrease in dialysis frequency (sessions/week) during follow-up132 (18%)95 (11%)14 (8%)
Decrease in dialysis session duration (minutes/session) during follow-up62 (9%)77 (9%)8 (5%)

Funding

  • NIDDK Support – Satellite Healthcare Inc., not-for-profit dialysis provider