Abstract: FR-PO120
Initial Outpatient Dialysis Orders in AKI-D vs. ESKD
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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
Many hospitalized patients with dialysis-requiring acute kidney (AKI-D) do not fully recover renal function and are discharged to continue hemodialysis at dialysis centers oriented toward treating patients with end-stage kidney disease (ESKD). Little is known about dialysis practice patterns in this population.
Methods
We examined initial outpatient dialysis orders for 1,754 AKI-D patients initiating in-center hemodialysis between 7/1/2017 and 6/30/2022 across 67 dialysis centers operated by a medium-sized, not-for-profit dialysis provider. For comparison, 6,197 contemporary patients initiating in-center hemodialysis for ESKD were identified.
Results
Patients initiating outpatient dialysis for AKI-D and ESKD had similar demographics (mean age, 63 in AKI-D vs 64 in ESKD; 60% male in both groups) and body mass indices (mean, 29 kg/m2 in both groups). However, mean pre-dialysis serum creatinine, interdialytic weight gain and pre-dialysis systolic blood pressure, were lower in the AKI-D group (5.3 versus 5.9 mg/dL, 0.9 versus 1.1 kg, and 135 versus 144 mmHg, respectively). Despite these differences, initial dialysis orders were similar. The initially prescribed hemodialysis frequency was 3x/week dialysis for 94% of AKI-D patients and 95% of ESKD patients. Hemodialysis session duration, dialysate sodium, and dialysate temperature were also similar.
Conclusion
Despite dissimilar medical profiles at hemodialysis initiation in the outpatient setting, initial hemodialysis orders for AKI-D and ESKD are largely the same. Greater individualization of dialysis orders may improve patient care.
Initial outpatient dialysis prescriptions in AKI-D and ESKD
| Incident AKI-D | Incident ESKD | |
| Sample size (N) | 1,754 | 6,197 |
| Treatment frequency 3 treatments/week | 94% | 95% |
| Session duration ≥4.0 hours | 20% | 23% |
| 3.5-3.9 hours | 35% | 37% |
| <3.5 hours | 45% | 40% |
| Dialysate sodium ≥140 mEq/L | 9% | 8% |
| 138-139 mEq/L | 52% | 49% |
| 136-137 mEq/L | 30% | 30% |
| <136 mEq/L | 9% | 13% |
| Dialysate potassium 3 mEq/L | 70% | 63% |
| 2 mEq/L | 29% | 37% |
| Other | <1% | <1% |
| Dialysate temperature Celsius, mean (SD) | 36.8 (0.5) | 36.8 (0.4) |
Funding
- NIDDK Support – Satellite Healthcare, Inc, not-for-profit dialysis provider