title: Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital.
abstract: BACKGROUND
  Recent policy clarifications by the Centers for Medicare & Medicaid 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.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  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).
  
  
  METHODS
  Baseline estimated glomerular filtration rate (eGFR), acute tubular necrosis from sepsis or surgery, heart failure, intensive care unit, and dialysis access.
  
  
  RESULTS
  Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis therapy discontinuation.
  
  
  RESULTS
  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; P<0.001), acute tubular necrosis from sepsis or surgery (HR, 3.34; 95% CI, 1.83-6.24; P<0.001), 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 (P<0.001).
  
  
  CONCLUSIONS
  Sample size.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN. Electronic address: hickson.latonya@mayo.edu.
authors.forename: LaTonya J
authors.initials: LJ
authors.lastname: Hickson
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chaudhary
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Amy W
authors.initials: AW
authors.lastname: Williams
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Norby
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: James R
authors.initials: JR
authors.lastname: Gregoire
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Albright
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: James T
authors.initials: JT
authors.lastname: McCarthy
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN; Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Bjorg
authors.initials: B
authors.lastname: Thorsteinsdottir
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Rule
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology*; D006435:Renal Dialysis; D012189:Retrospective Studies
keywords: Acute kidney injury (AKI); acute on chronic kidney disease; discontinuation of dialysis; end-stage renal disease (ESRD); heart failure; hospitalization; kidney function prognosis; renal recovery; renal replacement therapy (RRT); reversible renal injury; risk factors; transition to outpatient dialysis