Renal recovery after acute kidney injury requiring dialysis: Predictors and long-term outcomes

TL;DR

This study finds that about one-third of patients with acute kidney injury requiring dialysis recover kidney function, with vasopressor use during hospitalization as a key predictor.

Contribution

The study identifies vasopressor use as an independent predictor of renal recovery after acute kidney injury requiring dialysis.

Findings

31% of patients with AKI-D achieved renal recovery after discharge.

Vasopressor use during hospitalization was the only independent predictor of renal recovery.

Recovered patients had lower predialysis serum creatinine and more dialysis sessions than non-recovered patients.

Abstract

Acute kidney injury requiring dialysis (AKI-D) is a severe medical condition that is common and associated with a high rate of morbidity and mortality. Identifying predictors of kidney recovery in patients with AKI-D might lead to better care and improved kidney and patient survival. This study aims to assess the long-term clinical outcomes of patients who had AKI-D during their hospitalization and remained on dialysis at discharge and identify predictors of renal recovery after discharge.

We retrospectively studied adult patients hospitalized between January 2016 and December 2022 who had AKI-D during their hospitalization and continued receiving dialysis after discharge. Patients who had less than three months of follow-up, underwent kidney transplantation, or died within three months of dialysis initiation were excluded from the study.

Of the 64 patients in the study, 20 (31%) achieved renal recovery, while 44 (69%) remained dialysis dependent. The average time to renal recovery was 93 ± 61 days. Recovered AKI-D patients had significantly lower baseline and average weekly predialysis serum creatinine after discharge and significantly higher intensive care unit admission, length of hospital stay, vasopressor use, and number of dialysis sessions than non-recovered patients. Using multivariate analysis, we identified vasopressor use as the only independent predictor of renal recovery after discharge in patients with AKI-D (odds ratio, 16.244 [95% CI, 1.22–217.17]; P = 0.035).

Renal recovery after discharge can be seen in up to one-third of patients with AKI-D, even if they have advanced chronic kidney disease at baseline or require dialysis for more than three months. The chance of renal recovery is higher in patients who require vasopressor use during hospitalization. Thus, patients with AKI-D should be closely monitored after discharge, and guidelines on managing such patients need to be created.

Figures