Predictors and Outcomes of Post-Hospitalization Dialysis Dependent Acute Kidney Injury.

BACKGROUND: Acute kidney injury (AKI) is a frequent complication of hospitalized patients and is associated with poor outcomes. Hospitalized patients with AKI may need prolonged dialysis, necessitating post-hospitalization dialysis (PHD-AKI). Scarce information is available to stratify the risks and predict outcomes. This study aims to assess outcomes and identify predictors of outcomes of PHD-AKI within 90 days.
METHODS: All adult AKI patients initiating hemodialysis (HD) at the University of Virginia (UVA) between June 1, 2012, and September 30, 2013 were retrospectively studied. PHD-AKI patients continued treatment at a specifically designated unit. They were followed until an outcome (end-stage renal disease [ESRD], death or dialysis-independence) was achieved.
RESULTS: During the study period, 108 patients required outpatient dialysis out of 365 AKI patients initiating in-patient HD at UVA. An additional 11 patients who developed dialysis-requiring AKI at referring hospitals but underwent HD at our unit were included for a total of 119 patients studied. ESRD was declared in 48.7%, while 9.2% expired and 42.0% achieved dialysis independence. Congestive heart failure, baseline renal function and a prior episode of AKI within the preceding 6 months were statistically significant predictors of renal outcomes.
CONCLUSION: Dialysis independence of PHD-AKI patients is not uncommon. Certain clinical parameters may help predict renal outcome. Identifying predictors of renal recovery will guide further interventions, especially with the Centers for Medicare and Medicaid Services soon to allow AKI patients to be dialyzed at outpatient ESRD facilities. Ongoing biomarkers research may add further knowledge for optimum diagnosis and prognosis of AKI.