Abstract: PUB050
Outpatient Recovery From Acute Kidney Injury Requiring Dialysis (ORKID): A Pilot Trial
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical‚ Outcomes‚ and Trials
Authors
- McCoy, Ian, University of California San Francisco, San Francisco, California, United States
- Kwong, Yuenting Diana, University of California San Francisco, San Francisco, California, United States
- Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background
After leaving the hospital, patients with dialysis-requiring AKI (AKI-D) are currently treated largely the same as patients with end-stage kidney disease. Routine outpatient dialysis may result in low blood pressure during the dialysis session, which may further damage the kidneys and inhibit recovery. There is currently limited infrastructure supporting AKI-D recovery at outpatient dialysis facilities.
Methods
The ORKID trial (NCT05158153) is a single-center, single-arm pilot trial with target recruitment of 20 subjects with a primary aim to test the feasibility of providing a bundle of five interventions: chilled dialysate (35-36°C), high sodium dialysate (145 mmol/L), high dose diuretics (160 mg oral furosemide twice daily), high ultrafiltration hold threshold (SBP > 110 mmHg), and active dialysis weaning to patients with AKI-D being treated with outpatient hemodialysis. The bundled intervention aims to prevent intradialytic hypotension, recognize renal recovery, and wean dialysis off safely as soon as recovery occurs. Recruitment occurs before discharge from the University of California San Francisco (UCSF) hospitals and study investigators implement the intervention for participants during the first 90 days of outpatient dialysis at dialysis facilities within 30 miles of UCSF. The primary outcome is feasibility; secondary outcomes include tolerability (dropout to day 90), safety (including electrolyte abnormalities and emergent dialysis treatments), rates of recruitment, intradialytic hypotension, renal recovery, and patient reported outcomes.
Results
We identified 15 patients discharged with AKI-D still requiring HD. 10 patients lived outside the 30-mile radius for study inclusion (mean > 100 miles from UCSF). Four patients were excluded for clinician refusal or other reasons. One patient was recruited and underwent intervention but subsequently transitioned to hospice care. The trial was terminated after six months due to inadequate recruitment.
Conclusion
Given that outpatient dialysis facilities are often located far from the hospitals where AKI-D occurred, dialysis-unit based recruitment rather than hospital-based recruitment may be superior for trials of outpatient AKI-D recovery. Whether this bundled intervention to decrease intradialytic hypotension and support AKI-D recovery is feasible in outpatient dialysis units remains unknown.
Funding
- NIDDK Support – Satellite Healthcare, a not-for-profit renal care provider