ESRD Frequently Follows Dialysis-Dependent AKI
In a study, end-stage renal disease developed in 56% of patients discharged from a hospital with acute kidney injury requiring dialysis.
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NEW ORLEANS—Patients discharged from a hospital with acute kidney injury requiring dialysis (AKI-D) have a high incidence of transitioning to end-stage renal disease (ESRD), researchers reported at the American Society of Nephrology's Kidney Week 2017 meeting.
Possible risk factors associated with the development of ESRD include baseline chronic kidney disease (CKD), hypertension, and diabetes.
Samir A. Brahmbhatt, MD, and colleagues from Cleveland Clinic in Ohio studied 390 patients (median age 62 years; 62% male; 65% white) discharged with AKI-D to outpatient dialysis during 2010 to 2016. Most had multifactorial etiologies for AKI, with acute tubular necrosis the clinical diagnosis in two-thirds of patients. Another two-thirds required intensive care. With regard to comorbidities, patients most commonly had CKD (38%), hypertension (62%), diabetes (42%), heart failure (23%), and liver disease (20%).
ESRD developed in more than half of AKI-D patients (56%). Serum creatinine increased from 1.4 mg/dL at baseline to 5.8 mg/dL at dialysis initiation with limited urine output of 290 mL/day. In univariate analysis, factors associate with the development of ESRD included male gender, CKD, hypertension, diabetes mellitus, and heart failure.
“AKI-D patients require very close monitoring for renal recovery and avoidance of additional renal insults, such as intra-dialytic hypotension,” Dr Brahmbhatt told Renal & Urology News.
He added that the presence of factors associated with transition to ESRD, including baseline kidney disease, diabetes, and hypertension, should prompt nephrologists to discuss the likelihood of poor renal recovery and appropriate treatment options with patients and their families.
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Brahmbhatt SA, Armanyous S, Lioudis M, Heyka RJ, Wong LP, Demirjian S. High Incidence of transition to ESRD in patients discharged with dialysis dependent AKI: The Cleveland Clinic experience. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31-Nov. 5). Abstract FR-PO129.