KIDNEY RECOVERY AND DEATH IN OUTPATIENTS RISK GROUP (ReDO Risk group)
The ReDO risk group is generated to determine accurate expected probabilities of recovery to dialysis-independence (accounting for the competing risk of death) and death within one year in patients who continued outpatient dialysis after initiating dialysis in hospital.
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 currently exist 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, this model 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. It is an important step towards better prognostication with the ultimate aim of achieving better care for patients who require ongoing dialysis after hospitalization.