Abstract
BackgroundAcute kidney injury requiring dialysis (AKI-D) during hospitalization is associated with both in-hospital and post-discharge mortality. Its incidence has risen over time in Canada and the USA. While the majority of AKI-D will recover to dialysis independence at the time of hospital discharge, 10–30% will transition to outpatient dialysis. The risk factors that determine dialysis independence after AKI-D and its optimal outpatient management remain unclear. Eliciting prognostic predictors of kidney recovery in patients who remain on dialysis after hospital discharge will guide subsequent clinical decision making. The objective of this study is to assess the association between patient- and treatment-related factors with short- and long-term outcomes in patients who remained dialysis-dependent after hospitalization with AKI-D.MethodsA literature search in EMBASE, MEDLINE, and PubMed will be performed based on pre-specified criteria. There are no restrictions on language and publication dates. The supplemental search will include manual scan of bibliographies of eligible studies and grey literature assessment. Pre-specified criteria will be used to select eligible studies. Relevant data will be extracted and quality assessments performed per validated tools. Qualitative data synthesis will be performed to reflect directions of associations. Meta-analysis will be formed if two or more studies with similar prognostic factors, outcomes, and adequate quality are identified. Strength of association will be quantified as odds ratios. Reporting of this review will be guided by recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.DiscussionThis systematic review aims to synthesize association between modifiable and non-modifiable prognostic factors with renal outcomes in AKI-D patients who remain dialysis-dependent after hospital discharge. Our findings will help inform the development of evidence-based management and guide long-term treatment planning for AKI-D patients.Systematic review registrationPROSPERO registration number CRD42019127394.
Highlights
Acute kidney injury requiring dialysis (AKI-D) during hospitalization is associated with both in-hospital and post-discharge mortality
Eligibility criteria Types of studies All studies that have reported on predictors of kidney recovery and clinically relevant outcomes in AKI-D patients requiring post-hospitalization dialysis are eligible
The following criteria must be met: Patient populations: Patients 18 years or older with acute kidney injury treated with dialysis of any type during a hospitalization who transition to outpatient dialysis after hospital discharge
Summary
Acute kidney injury requiring dialysis (AKI-D) during hospitalization is associated with both in-hospital and post-discharge mortality. While the majority of AKI-D will recover to dialysis independence at the time of hospital discharge, 10–30% will transition to outpatient dialysis. An improved understanding of predictors of kidney recovery to dialysis independence in outpatients who require ongoing dialysis after a hospital encounter with AKI-D (as well as the gaps in knowledge in this area) can improve patient-centered decision-making and clarify the need for further research in this area. For patients unlikely to have kidney recovery, earlier and better-informed decision-making regarding long-term arteriovenous access, home therapies, and transplantation would be facilitated. This could improve patients’ quality of care; improve access, integration, and utilization of chronic kidney disease system resources; and improve access to transplant and home dialysis. A better understanding of the risks of death and dialysis dependence would help patients navigate their options regarding palliative/conservative care after having gained some experience as to what is involved in undergoing maintenance dialysis in the outpatient setting
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