Long-Term Outcomes and Associated Risk Factors of Post-Hospitalization Dialysis-Dependent Acute Kidney Injury Patients

Abstract

Background/Aims: Acute kidney injury requiring dialysis (AKI-D) is associated with poor outcomes. Centers for Medicare and Medicaid Services have reversed their clarification allowing AKI-D patients to be dialyzed at outpatient dialysis units. Data assessing long-term outcomes of AKI-D patients and their predictors is needed to adopt guidelines to ensure adequate management. We assessed long-term outcomes and associated risk factors of AKI-D patients who survived 90 days post-hemodialysis (HD) initiation. Methods: AKI-D patients surviving hospitalization and dialyzed at a specialized outpatient AKI dialysis unit between April 11, 2012 and December 25, 2013 were prospectively followed. Long-term outcomes of AKI-D patients were obtained by a single provider through a telephone survey, and factors affecting their outcomes were statistically analyzed. Results: Ninety-one out of 108 patients were reached for telephone survey. At baseline (90 days post-HD initiation), 52/91 patients were declared end-stage renal disease (ESRD; group 1) and 39/91 were dialysis-independent (group 2). At the end of an average follow up period of 859.7 days, 32/91 (35.2%) were dialysis-independent (3/52 from group 1 and 29/39 from group 2), with 28/91 dead (25/52 from group 1 and 3/39 from group 2). After adjusting for demographics and comorbidities, baseline renal function, prior AKI, ESRD, and requirement for continuous renal replacement therapy were associated with poor outcomes. Conclusions: Sustaining long-term dialysis independence in AKI-D patients is significant. Baseline renal function, prior AKI, and hemodynamic changes during hospitalization are predictors of long-term outcomes. Meticulous follow up of AKI-D patients in the outpatient dialysis facilities in their first 90 days post-HD initiation is crucial.