Kidney Week

Abstract: FR-PO074

Hemodialysis Factors Associated with Kidney Function Recovery in Patients with AKI Receiving Outpatient Dialysis

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Babroudi, Seda, Tufts Medical Center, Boston, Massachusetts, United States

Seda Babroudi, MD

• Tighiouart, Hocine, Tufts Medical Center Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, United States

Hocine Tighiouart, MS

• Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States

Daniel E. Weiner, MD, MS, FASN

• Neyra, Javier A., UAB Hospital, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

• Sanders, Ronald, Dialysis Clinic Inc, Nashville, Tennessee, United States

Ronald Sanders

• Manley, Harold, Dialysis Clinic Inc, Nashville, Tennessee, United States

Harold Manley, PharmD, FASN

• Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States

Eduardo K. Lacson, MD, MPH, FASN

• Drew, David A., Tufts Medical Center, Boston, Massachusetts, United States

David A. Drew, MD, MS

Background

Patients with acute kidney injury receiving outpatient dialysis (AKI-D) represent 10% or more of annual new hemodialysis starts in the United States, of whom approximately one-third recover kidney function. We examined the relationship of novel hemodialysis prescription factors with kidney function recovery in patients with AKI-D.

Methods

Using a multi-center retrospective cohort design, we evaluated the association of hemodialysis treatment frequency, treatment duration, ultrafiltration rate, net ultrafiltration, intradialytic hypotension, and dialysate temperature and electrolyte concentrations at baseline with kidney function recovery to dialysis independence among patients with AKI-D who initiated dialysis between 2017 and 2021 at a medium-sized dialysis provider. We used Cox proportional hazard models adjusting for demographic and clinical factors.

Results

2,544 adults with AKI-D treated across 238 dialysis facilities were analyzed. The mean (SD) age was 65 (14.2) years, 58% were men, and 19% were Black. A total of 857 (34%) patients recovered kidney function, with a median (IQR) time-to-kidney function recovery of 29 (17,54) days. Fewer than three hemodialysis treatments per week significantly positively associated with kidney function recovery as compared to three or more treatments per week in the first thirty days. Longer treatment duration, higher net ultrafiltration, and higher ultrafiltration rate significantly negatively associated with kidney function recovery after multivariable adjustment (Table 1). Intradialytic hypotension and hemodialysate characteristics did not associate with kidney function recovery.

Conclusion

Among patients with AKI-D, longer treatment duration, higher net ultrafiltration, and higher ultrafiltration rate significantly negatively associated with kidney function recovery. Fewer than three hemodialysis treatments per week, however, significantly positively associated with kidney function recovery. These results support further study of ultrafiltration rate thresholds and dialysis deprescribing to promote kidney recovery.

Funding

• Other NIH Support