Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital

LaTonya Hickson, Sanjay Chaudhary, Amy W. Williams, John J. Dillon, Suzanne M. Norby, James R. Gregoire, Robert C. Albright, James T. McCarthy, Bjoerg (Bjorg) Thorsteinsdottir, Andrew D Rule

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background Recent policy clarifications by the Centers for Medicare & Medicaid Services have changed access to outpatient dialysis care at end-stage renal disease (ESRD) facilities for individuals with acute kidney injury in the United States. Tools to predict "ESRD" and "acute" status in terms of kidney function recovery among patients who previously initiated dialysis therapy in the hospital could help inform patient management decisions. Study Design Historical cohort study. Setting & Participants Incident hemodialysis patients in the Mayo Clinic Health System who initiated in-hospital renal replacement therapy (RRT) and continued outpatient dialysis following hospital dismissal (2006 through 2009). Predictor Baseline estimated glomerular filtration rate (eGFR), acute tubular necrosis from sepsis or surgery, heart failure, intensive care unit, and dialysis access. Outcomes Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis therapy discontinuation. Results Cohort consisted of 281 patients with a mean age of 64 years, 63% men, 45% with heart failure, and baseline eGFR ≥ 30 mL/min/1.73 m<sup>2</sup> in 46%. During a median of 8 months, 52 (19%) recovered, most (94%) within 6 months. Higher baseline eGFR (HR per 10-mL/min/1.73 m<sup>2</sup> increase eGFR, 1.27; 95% CI, 1.16-1.39; P < 0.001), acute tubular necrosis from sepsis or surgery (HR, 3.34; 95% CI, 1.83-6.24; P < 0.001), and heart failure (HR, 0.40; 95% CI, 0.19-0.78, P = 0.007) were independent predictors of recovery within 6 months, whereas first RRT in the intensive care unit and catheter dialysis access were not. There was a positive interaction between absence of heart failure and eGFR ≥ 30 mL/min/1.73 m<sup>2</sup> for predicting kidney function recovery (P < 0.001). Limitations Sample size. Conclusions Kidney function recovery in the outpatient hemodialysis unit following in-hospital RRT initiation is not rare. As expected, higher baseline eGFR is an important determinant of recovery. However, patients with heart failure are less likely to recover even with a higher baseline eGFR. Consideration of these factors at hospital discharge informs decisions on ESRD status designation and long-term hemodialysis care.

Original languageEnglish (US)
Pages (from-to)592-602
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume65
Issue number4
DOIs
StatePublished - Apr 1 2015

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Recovery of Function
Glomerular Filtration Rate
Renal Dialysis
Outpatients
Kidney
Dialysis
Chronic Kidney Failure
Renal Replacement Therapy
Heart Failure
Medicaid
Long-Term Care
Ambulatory Care
Medicare
Acute Kidney Injury
Sample Size
Intensive Care Units
Sepsis
Cohort Studies
Necrosis
Health

Keywords

  • Acute kidney injury (AKI)
  • acute on chronic kidney disease
  • discontinuation of dialysis
  • end-stage renal disease (ESRD)
  • heart failure.
  • hospitalization
  • kidney function prognosis
  • renal recovery
  • renal replacement therapy (RRT)
  • reversible renal injury
  • risk factors
  • transition to outpatient dialysis

ASJC Scopus subject areas

  • Nephrology

Cite this

Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital. / Hickson, LaTonya; Chaudhary, Sanjay; Williams, Amy W.; Dillon, John J.; Norby, Suzanne M.; Gregoire, James R.; Albright, Robert C.; McCarthy, James T.; Thorsteinsdottir, Bjoerg (Bjorg); Rule, Andrew D.

In: American Journal of Kidney Diseases, Vol. 65, No. 4, 01.04.2015, p. 592-602.

Research output: Contribution to journalArticle

Hickson, LaTonya ; Chaudhary, Sanjay ; Williams, Amy W. ; Dillon, John J. ; Norby, Suzanne M. ; Gregoire, James R. ; Albright, Robert C. ; McCarthy, James T. ; Thorsteinsdottir, Bjoerg (Bjorg) ; Rule, Andrew D. / Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital. In: American Journal of Kidney Diseases. 2015 ; Vol. 65, No. 4. pp. 592-602.
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abstract = "Background Recent policy clarifications by the Centers for Medicare & Medicaid Services have changed access to outpatient dialysis care at end-stage renal disease (ESRD) facilities for individuals with acute kidney injury in the United States. Tools to predict {"}ESRD{"} and {"}acute{"} status in terms of kidney function recovery among patients who previously initiated dialysis therapy in the hospital could help inform patient management decisions. Study Design Historical cohort study. Setting & Participants Incident hemodialysis patients in the Mayo Clinic Health System who initiated in-hospital renal replacement therapy (RRT) and continued outpatient dialysis following hospital dismissal (2006 through 2009). Predictor Baseline estimated glomerular filtration rate (eGFR), acute tubular necrosis from sepsis or surgery, heart failure, intensive care unit, and dialysis access. Outcomes Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis therapy discontinuation. Results Cohort consisted of 281 patients with a mean age of 64 years, 63{\%} men, 45{\%} with heart failure, and baseline eGFR ≥ 30 mL/min/1.73 m2 in 46{\%}. During a median of 8 months, 52 (19{\%}) recovered, most (94{\%}) within 6 months. Higher baseline eGFR (HR per 10-mL/min/1.73 m2 increase eGFR, 1.27; 95{\%} CI, 1.16-1.39; P < 0.001), acute tubular necrosis from sepsis or surgery (HR, 3.34; 95{\%} CI, 1.83-6.24; P < 0.001), and heart failure (HR, 0.40; 95{\%} CI, 0.19-0.78, P = 0.007) were independent predictors of recovery within 6 months, whereas first RRT in the intensive care unit and catheter dialysis access were not. There was a positive interaction between absence of heart failure and eGFR ≥ 30 mL/min/1.73 m2 for predicting kidney function recovery (P < 0.001). Limitations Sample size. Conclusions Kidney function recovery in the outpatient hemodialysis unit following in-hospital RRT initiation is not rare. As expected, higher baseline eGFR is an important determinant of recovery. However, patients with heart failure are less likely to recover even with a higher baseline eGFR. Consideration of these factors at hospital discharge informs decisions on ESRD status designation and long-term hemodialysis care.",
keywords = "Acute kidney injury (AKI), acute on chronic kidney disease, discontinuation of dialysis, end-stage renal disease (ESRD), heart failure., hospitalization, kidney function prognosis, renal recovery, renal replacement therapy (RRT), reversible renal injury, risk factors, transition to outpatient dialysis",
author = "LaTonya Hickson and Sanjay Chaudhary and Williams, {Amy W.} and Dillon, {John J.} and Norby, {Suzanne M.} and Gregoire, {James R.} and Albright, {Robert C.} and McCarthy, {James T.} and Thorsteinsdottir, {Bjoerg (Bjorg)} and Rule, {Andrew D}",
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T1 - Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital

AU - Hickson, LaTonya

AU - Chaudhary, Sanjay

AU - Williams, Amy W.

AU - Dillon, John J.

AU - Norby, Suzanne M.

AU - Gregoire, James R.

AU - Albright, Robert C.

AU - McCarthy, James T.

AU - Thorsteinsdottir, Bjoerg (Bjorg)

AU - Rule, Andrew D

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background Recent policy clarifications by the Centers for Medicare & Medicaid Services have changed access to outpatient dialysis care at end-stage renal disease (ESRD) facilities for individuals with acute kidney injury in the United States. Tools to predict "ESRD" and "acute" status in terms of kidney function recovery among patients who previously initiated dialysis therapy in the hospital could help inform patient management decisions. Study Design Historical cohort study. Setting & Participants Incident hemodialysis patients in the Mayo Clinic Health System who initiated in-hospital renal replacement therapy (RRT) and continued outpatient dialysis following hospital dismissal (2006 through 2009). Predictor Baseline estimated glomerular filtration rate (eGFR), acute tubular necrosis from sepsis or surgery, heart failure, intensive care unit, and dialysis access. Outcomes Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis therapy discontinuation. Results Cohort consisted of 281 patients with a mean age of 64 years, 63% men, 45% with heart failure, and baseline eGFR ≥ 30 mL/min/1.73 m2 in 46%. During a median of 8 months, 52 (19%) recovered, most (94%) within 6 months. Higher baseline eGFR (HR per 10-mL/min/1.73 m2 increase eGFR, 1.27; 95% CI, 1.16-1.39; P < 0.001), acute tubular necrosis from sepsis or surgery (HR, 3.34; 95% CI, 1.83-6.24; P < 0.001), and heart failure (HR, 0.40; 95% CI, 0.19-0.78, P = 0.007) were independent predictors of recovery within 6 months, whereas first RRT in the intensive care unit and catheter dialysis access were not. There was a positive interaction between absence of heart failure and eGFR ≥ 30 mL/min/1.73 m2 for predicting kidney function recovery (P < 0.001). Limitations Sample size. Conclusions Kidney function recovery in the outpatient hemodialysis unit following in-hospital RRT initiation is not rare. As expected, higher baseline eGFR is an important determinant of recovery. However, patients with heart failure are less likely to recover even with a higher baseline eGFR. Consideration of these factors at hospital discharge informs decisions on ESRD status designation and long-term hemodialysis care.

AB - Background Recent policy clarifications by the Centers for Medicare & Medicaid Services have changed access to outpatient dialysis care at end-stage renal disease (ESRD) facilities for individuals with acute kidney injury in the United States. Tools to predict "ESRD" and "acute" status in terms of kidney function recovery among patients who previously initiated dialysis therapy in the hospital could help inform patient management decisions. Study Design Historical cohort study. Setting & Participants Incident hemodialysis patients in the Mayo Clinic Health System who initiated in-hospital renal replacement therapy (RRT) and continued outpatient dialysis following hospital dismissal (2006 through 2009). Predictor Baseline estimated glomerular filtration rate (eGFR), acute tubular necrosis from sepsis or surgery, heart failure, intensive care unit, and dialysis access. Outcomes Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis therapy discontinuation. Results Cohort consisted of 281 patients with a mean age of 64 years, 63% men, 45% with heart failure, and baseline eGFR ≥ 30 mL/min/1.73 m2 in 46%. During a median of 8 months, 52 (19%) recovered, most (94%) within 6 months. Higher baseline eGFR (HR per 10-mL/min/1.73 m2 increase eGFR, 1.27; 95% CI, 1.16-1.39; P < 0.001), acute tubular necrosis from sepsis or surgery (HR, 3.34; 95% CI, 1.83-6.24; P < 0.001), and heart failure (HR, 0.40; 95% CI, 0.19-0.78, P = 0.007) were independent predictors of recovery within 6 months, whereas first RRT in the intensive care unit and catheter dialysis access were not. There was a positive interaction between absence of heart failure and eGFR ≥ 30 mL/min/1.73 m2 for predicting kidney function recovery (P < 0.001). Limitations Sample size. Conclusions Kidney function recovery in the outpatient hemodialysis unit following in-hospital RRT initiation is not rare. As expected, higher baseline eGFR is an important determinant of recovery. However, patients with heart failure are less likely to recover even with a higher baseline eGFR. Consideration of these factors at hospital discharge informs decisions on ESRD status designation and long-term hemodialysis care.

KW - Acute kidney injury (AKI)

KW - acute on chronic kidney disease

KW - discontinuation of dialysis

KW - end-stage renal disease (ESRD)

KW - heart failure.

KW - hospitalization

KW - kidney function prognosis

KW - renal recovery

KW - renal replacement therapy (RRT)

KW - reversible renal injury

KW - risk factors

KW - transition to outpatient dialysis

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