KIDNEY RECOVERY AND DEATH IN OUTPATIENTS RISK GROUP (ReDO Risk group)

Dialysis is initiated in hospital for management of acute kidney injury (AKI) or advanced chronic kidney disease (CKD) and overlap of AKI on CKD. AKI treated with dialysis (AKI-D) occurs in about 2% of all hospitalized patients. Approximately 50% of AKI-D patients survive their index hospitalization, of whom up to 30% remain dialysis-dependent following discharge. These patients continue their dialysis treatments as outpatients with approximately half recovering enough kidney function to discontinue dialysis within 90 days. After 90 days only about 5% additional patients recover sufficient kidney function to stop dialysis. Of all patients with AKI-D who survive to discharge, about 35% die within 6 months, most commonly from cardiovascular disease. No predictive models have previously been designed to estimate a patient's likelihood of kidney recovery to dialysis-independence or death when discharged to continue dialysis following a hospitalization. An improved understanding of these risks could improve outpatient dialysis management for this patient population.
To help address this knowledge gap, ReDo Risk groups were derived and externally validated risk indexes to predict the likelihood of recovery to dialysis-independence and of death within one year after discharge for patients continuing outpatient dialysis after in-hospital dialysis initiation. Death risk and recovery risk increases with higher scores.
In conclusion, these models derived and validated a risk index for predicting recovery of kidney function or death in the year after discharge from hospital for patients who initiate dialysis. This is an important step towards better prognostication with the ultimate aim of achieving better care for patients who require ongoing dialysis after hospitalization.