Dialysis-requiring acute kidney injury (AKI-D) is one of the most serious complications for hospitalized patients. Renal recovery after AKI-D ? defined as return of sufficient native kidney function to come off dialysis ? is a critically important clinical and patient-oriented outcome. However, we currently have limited ability to predict recovery in an individual AKI-D patient, and there are no interventions proven to improve the likelihood of recovery. Our overall goal is to improve outcomes in patients with AKI-D. We propose to develop and validate a clinical prediction model for recovery after AKI-D using an established database from a large integrated health-care delivery system. Guided by our prediction model, we will also conduct a small, single-center pilot randomized controlled trial among AKI-D patients with a reasonable chance of recovery to test the feasibility and safety of a conservative dialysis strategy, in which dialysis is not continued unless specific metabolic or clinical indications for dialysis are present. We hypothesize that, compared to the conventional practice of thrice-weekly dialysis, a conservative dialysis strategy will reduce the number of acute hemodialysis sessions needed and improve the likelihood of renal recovery. This pilot study will play several key roles in the design of a larger future trial by identifying potential barriers to recruitment and affording the opportunity to optimize intervention delivery.
Our specific aims are:
Aim 1. To derive a clinical prediction model to predict the chances of renal recovery after AKI-D by 90 days after initiation of renal replacement therapy.
Aim 2. Among AKI-D patients classified as having >30% chance of recovery, to determine the feasibility/safety of and adherence to a strategy of conservative dialysis strategy in a single-center pilot randomized clinical trial (n=20).
Each year, there are >125,000 patients in the United States who survive a hospital admission complicated by dialysis- requiring acute kidney injury (AKI-D). Up to one-third remain dialysis-dependent at time of hospital discharge, and 80% of these patients remain dialysis-dependent at six months. The long-term goals of this research are to shorten the duration of dialysis need and improve the fraction of AKI-D patients who recover kidney function, both of which will have major public-health and cost-saving impacts.
| Lee, Benjamin J; Johansen, Kirsten L; McCulloch, Charles E et al. (2018) Potential Impact of Medicare Payment Policy on Misclassification of Dialysis-Requiring Acute Kidney Injury as ESRD: A National Temporal Trend Analysis. Am J Kidney Dis 72:311-313 |
| Lee, Benjamin J; Hsu, Chi-Yuan; Parikh, Rishi V et al. (2018) Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study. BMC Nephrol 19:134 |
| Lee, Benjamin J; Go, Alan S; Parikh, Rishi et al. (2018) Pre-admission proteinuria impacts risk of non-recovery after dialysis-requiring acute kidney injury. Kidney Int 93:968-976 |
