WASHINGTON—Younger age, female sex, and lower serum creatinine are among the demographic and biochemical variables most strongly associated with recovery of kidney function after initiation of outpatient hemodialysis (HD) for acute kidney injury (AKI), according to new study findings presented at the American Society of Nephrology’s 2019 Kidney Week conference suggest. Higher serum creatinine is most strongly associated with transition to end-stage renal disease (ESRD).
“It’s very significant to finally have national data on individuals with acute kidney injury treated in outpatient dialysis facilities,” investigator Franklin W. Maddux, MD, Global Chief Medical Officer at Fresenius Medical Care North America (FMCNA), told Renal & Urology News. “We have been undertaking studies to further understand the clinical course of acute kidney injury necessitating outpatient dialysis care.”
This particular research, which is one of several studies of AKI that FMCNA is presenting at the conference, is helping the company to better identify factors associated with either recovery of kidney function or transition to ESRD, he said.
Dr Maddux added, “We will continue to conduct research that improves our understanding of the treatment of AKI in the outpatient dialysis setting in order to create more personalized care that increases the likelihood of recovery of kidney function or supports the transition to end stage kidney disease when recovery of kidney function is not possible.”
The new study included 12,221 patients who initiated outpatient HD for AKI at a Fresenius Kidney Care dialysis facility from May 1, 2017 to December 31, 2018. During follow-up, 4786 (39%) recovered kidney function, 5606 (46%) transitioned to ESRD, and 1136 (9%) died, the investigators reported in a poster presentation. Results showed that each standard deviation (SD) increase in age (14.6 years) was significantly associated with a 22% decreased likelihood of recovering kidney function and a 5% increased risk of transitioning to ESRD in adjusted analyses. Female sex was significantly associated with a 24% increased likelihood of recovering kidney function compared with male sex and a 14% decreased likelihood of transitioning to ESRD. Each SD increase in serum creatinine (2.3 mg/dL) was significantly associated with a 35% decreased likelihood of recovering kidney function and 27% increased risk of transitioning to ESRD.
Additionally, each SD increase in serum potassium (0.6 mEq/L) was significantly associated with a 15% decreased likelihood of recovering kidney function and 12% increased risk of transitioning to ESRD. Each SD increase in serum phosphorus (1.5 mg/dL) was significantly associated with a 31% increased likelihood of recovering kidney function and 16% decreased risk of transitioning to ESRD.
“In patients initiating outpatient dialysis for the treatment of AKI, we found that age, sex, lower serum creatinine, and higher serum phosphorus — with biochemistry measured during the first week of outpatient dialysis — were all strongly associated with recovery of enough kidney function to discontinue dialysis,” said first author Eric D. Weinhandl, PhD, MS, Senior Director of Epidemiology and Biostatistics at FMCNA. “In contrast, higher serum creatinine was associated with transition to end-stage kidney disease. Unmeasured factors, including the presence of chronic kidney disease and the cause of AKI, certainly influence the likelihood of recovery of kidney function. Still, these results show that physicians and patients may be able to incorporate information from early biochemical measurements into their assessment of the potential for resolution of AKI.”
Read more of Renal & Urology News’ coverage of Kidney Week 2019 by visiting the conference page.
Weinhandl ED, Dalrymple LS, Sun Y, et al. Predictors of recovery of kidney function and transition to ESKD in patients on outpatient dialysis for AKI. Presented at the American Society of Nephrology’s 2019 Kidney Week conference held November 5 to 10 in Washington, DC. Poster FR-PO008.