A risk model accurately categorized patients with an inpatient episode of acute kidney injury into clinically distinct groups according to likelihood of either death or recovery of kidney function and ability to discontinue dialysis after hospital discharge, according to a published study.
“There are several reasons why the accurate and timely prediction of recovery is important,” Edward G. Clark, MD, MSc, of the division of nephrology in the department of medicine at the Ottawa Hospital, University of Ottawa in Canada, and colleagues wrote. “In addition to providing meaningful information to patients and their families, it could permit both targeted monitoring for recovery and the tailored use of strategies to limit further kidney injury. [Furthermore], knowledge that recovery is unlikely will enable clinicians and patients to shift their focus to issues that are germane to ESKD care, with education on dialysis access planning, home dialysis and transplantation. At present, there is no tool that simultaneously incorporates multiple health characteristics to estimate a patient’s likelihood of death and dialysis independence in the year after they survive a hospital encounter with AKI treated with dialysis and transition to outpatient dialysis care.”
To more fully describe the factors that predict whether such patients will die or recover kidney function, researchers conducted a retrospective population-based cohort study of 2,771 patients who required outpatient dialysis after an inpatient episode of AKI in Ontario, Canada, between January 2008 and September 2015 (mean age, 67 years; 65% were men).
Age, comorbid conditions (50.3% with congestive heart failure; 60.1% with diabetes), discharge disposition, eGFR (49.3% with mean eGFR between 15 mL/min/1.73m2 to 29 mL/min/1.73m2) and urinary albumin-creatinine ratio (25.3% >30 mg/mmol) before AKI were all considered.
A risk model accurately categorized patients with an inpatient episode of acute kidney injury into clinically distinct groups according to likelihood of either death or recovery of kidney function and ability to discontinue dialysis after hospital discharge.
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Researchers used a model-based point system to generate quartiles of risk, classifying patients into death or recovery after AKI (DRAKI) risk groups. The primary outcomes of the study were death or the recovery of kidney function sufficient to stop dialysis at 1 year after hospital discharge.
Researchers found that, after 1 year, 26.6% of the study population had died, 18.8% were alive and no longer required dialysis and 54% were receiving ongoing dialysis. Older age, higher modified Charlson comorbidity score, history of cancer and discharge disposition were independently associated with a greater 1-year probability of death. Higher baseline eGFR and lower baseline urinary albumin-creatinine ratio were independently associated with a higher 1-year probability of no longer requiring dialysis.
“We have successfully derived and internally validated a scoring system to independently predict the probability of recovery to dialysis independence and death within 1 year after transitioning to outpatient dialysis following hospitalization with AKI treated with dialysis,” the researchers wrote. “Our study is an initial step toward providing better care for AKI treated with dialysis survivors who require ongoing dialysis after hospitalization. Patients determined likely to be alive but still requiring dialysis at 1 year could have their dialysis care optimized by expediting consideration of home therapies, arteriovenous access and evaluation of transplantation. Finally, those at high risk for death could make better informed decisions regarding their overall goals of care with the additional understanding that recovery to dialysis independence is unlikely.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.