American Journal of Nephrology

Patient-Oriented, Translational Research: Research Article

Ortiz-Soriano V. · Cama-Olivares A. · Liu L.J. · Armentrout B. · Colohan D. · Paladiya R. · Babroudi S. · Aycinena J.-C. · Neyra J.A.

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Article / Publication Details Abstract

Introduction: In 2017, the Centers for Medicare and Medicaid Services allowed survivors of hospitalized acute kidney injury requiring dialysis (AKI-D) who were ambulatory and still dependent on hemodialysis (HD) to receive treatment in outpatient dialysis facilities. This policy change generated the ongoing need to improve AKI-D care in the outpatient setting. Methods: Quality improvement study in adult patients admitted to an outpatient HD unit with the diagnosis of AKI-D. We developed a protocol to manage these patients that included: a) multidisciplinary evaluations; b) personalized 3-tier HD prescription for dose/ultrafiltration rate and frequency; c) weekly assessment of kidney recovery; and d) patient empowerment. Patient- and protocol-specific characteristics were described. We analyzed hourly HD data and protocol adherence, and relevant hemodynamic data were compared according to HD-free survival at 90 days. Results: A total of 457.3 hours of HD from nine patients under the AKI-D protocol were interrogated. Three out of nine patients were alive and liberated from HD within the first 90 days of outpatient HD. Overall protocol adherence was 53.8% and did not differ by HD-free survival (54.5% vs. 53.7% in those that recovered vs. not). Protocol adherence was associated with fewer intradialytic hypotension events (peak to nadir BP, p

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