Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital
| Autor: | Sanjay Chaudhary, Suzanne M. Norby, Bjoerg Thorsteinsdottir, La Tonya J. Hickson, Robert C. Albright, Andrew D. Rule, James T. McCarthy, James R. Gregoire, John J. Dillon, Amy W. Williams |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Renal function Kidney Article law.invention Cohort Studies law Predictive Value of Tests Renal Dialysis Internal medicine Outpatients medicine Humans Renal replacement therapy Intensive care medicine Dialysis Aged Retrospective Studies Aged 80 and over Heart Failure Inpatients business.industry Incidence Acute kidney injury Retrospective cohort study Recovery of Function Middle Aged medicine.disease Intensive care unit Intensive Care Units Nephrology Kidney Failure Chronic Female Hemodialysis business Cohort study Glomerular Filtration Rate |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation. 65(4) |
| ISSN: | 1523-6838 |
| Popis: | Recent policy clarifications by the Centers for MedicareMedicaid Services have changed access to outpatient dialysis care at end-stage renal disease (ESRD) facilities for individuals with acute kidney injury in the United States. Tools to predict "ESRD" and "acute" status in terms of kidney function recovery among patients who previously initiated dialysis therapy in the hospital could help inform patient management decisions.Historical cohort study.Incident hemodialysis patients in the Mayo Clinic Health System who initiated in-hospital renal replacement therapy (RRT) and continued outpatient dialysis following hospital dismissal (2006 through 2009).Baseline estimated glomerular filtration rate (eGFR), acute tubular necrosis from sepsis or surgery, heart failure, intensive care unit, and dialysis access.Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis therapy discontinuation.Cohort consisted of 281 patients with a mean age of 64 years, 63% men, 45% with heart failure, and baseline eGFR≥30mL/min/1.73m(2) in 46%. During a median of 8 months, 52 (19%) recovered, most (94%) within 6 months. Higher baseline eGFR (HR per 10-mL/min/1.73m(2) increase eGFR, 1.27; 95% CI, 1.16-1.39; P0.001), acute tubular necrosis from sepsis or surgery (HR, 3.34; 95% CI, 1.83-6.24; P0.001), and heart failure (HR, 0.40; 95% CI, 0.19-0.78, P=0.007) were independent predictors of recovery within 6 months, whereas first RRT in the intensive care unit and catheter dialysis access were not. There was a positive interaction between absence of heart failure and eGFR≥30mL/min/1.73m(2) for predicting kidney function recovery (P0.001).Sample size.Kidney function recovery in the outpatient hemodialysis unit following in-hospital RRT initiation is not rare. As expected, higher baseline eGFR is an important determinant of recovery. However, patients with heart failure are less likely to recover even with a higher baseline eGFR. Consideration of these factors at hospital discharge informs decisions on ESRD status designation and long-term hemodialysis care. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|