American Journal of Nephrology

Patient-Oriented, Translational Research: Research Article

Ortiz-Soriano V.a· Cama-Olivares A.b· Liu L.J.c,d· Armentrout B.a· Colohan D.e· Paladiya R.a· Babroudi S.f· Aycinena J.-C.a· Neyra J.A.a,b

Author affiliations

aDivision of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
bDivision of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
cDepartment of Computer Science, University of Kentucky, Lexington, KY, USA
dDepartment of Internal Medicine, Division of Biomedical Informatics, University of Kentucky, Lexington, KY, USA
eCollege of Medicine, University of Kentucky, Lexington, KY, USA
fDivision of Nephrology, Tufts Medical Center, Boston, MA, USA

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Article / Publication Details

Received: January 12, 2023
Accepted: March 27, 2023
Published online: April 08, 2023

Number of Print Pages: 11
Number of Figures: 4
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

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 h of HD from 9 patients under the AKI-D protocol were interrogated. Three out of 9 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 blood pressure, p < 0.01), while intradialytic hypotension (pre- to post-blood pressure) occurred more frequently in patients who did not recover kidney function (p = 0.009). Conclusion: We demonstrated the feasibility of implementing a management protocol for AKI-D patients in an outpatient dialysis facility. We found that fewer episodes of intradialytic hypotension occurred when the outpatient HD management was adherent to the protocol. The feasibility of this protocol should be confirmed in other facilities, and importantly, efficacy testing to evaluate its impact on AKI-D outpatient care is necessary.

© 2023 S. Karger AG, Basel

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Received: January 12, 2023
Accepted: March 27, 2023
Published online: April 08, 2023

Number of Print Pages: 11
Number of Figures: 4
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

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