Brief dialysis may be best for some kidney patients (Acute injury should not require permanent dialysis

Patients with acute kidney injury requiring outpatient dialysis after hospital discharge receive the same care as those with the more common end-stage kidney disease, according to a study.

But while patients with the latter diagnosis—typically caused by long-standing hypertension or diabetes—must remain on lifelong dialysis or receive a new kidney, some patients on dialysis for acute kidney injury have the potential to recover, the researchers reported.

Acute kidney injury may result from acute infection or shock, causing reduced blood flow to the kidneys, as well as major surgeries and chemotherapy agents that are toxic to the kidneys.

Researchers tracked data from 1,754 patients with acute kidney injury and 6,197 patients with end-stage kidney disease at outpatient dialysis centers. Although lab tests suggested acute kidney injury patients needed less dialysis, the two groups were treated largely the same. Both were started on thrice-weekly dialysis, and the large majority of patients in both groups were not tested for kidney functioning in the first month of treatment.

Among the acute kidney injury patients, 10% died during the three-month study period—most likely from the conditions that prompted dialysis, according to the researchers. Of the 41% of patients who recovered kidney function, approximately three-quarters had discontinued dialysis without any changes to the dose, frequency and duration. This suggests that these patients could have been weaned at an earlier point, researchers noted.

For kidney specialists taking care of acute kidney injury patients and dialysis providers operating the outpatient centers, there are powerful disincentives to wean patients off dialysis, McCoy said.

Approximately half of the patients neither died nor discontinued dialysis by the end of the study. For them, the future looked uncertain, said Chi-yuan Hsu, MD. "After about three months of dialysis, they almost always are treated like they will remain on dialysis indefinitely," he said.