Kincaid, Hope, MPH, CPH

Maynard, Sharon E, MD

Olaso, Aedan, MD

Tseytlin, Daniel, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineOutcomes in Patients with Persistent Dialysis-Dependent Acute Kidney InjuryAedan Olaso MDLehigh Valley Health Network, Aedan.Olaso@lvhn.orgDaniel Tseytlin DOLehigh Valley Health Network, Daniel.Tseytlin@lvhn.orgHope Kincaid MPH, CPHLehigh Valley Health Network, Hope.Kincaid@lvh.comSharon E. Maynard MDLehigh Valley Health Network, Sharon_E.Maynard@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtOlaso, A., Tseytlin, D., Kincaid, H., Maynard, S. (2015, November 5). Outcomes in Patients with Persistent Dialysis-Dependent AcuteKidney Injury. Poster presented at: American Society of Nephrology (ASN), San Diego, CA.1Div. of Nephrology, 2Dept. of Internal Medicine, 3Network Office of Research & Innovation, Lehigh Valley Health Network, Allentown, PennsylvaniaOutcomes in Patients with Persistent Dialysis-Dependent Acute Kidney InjuryAedan Olaso,1 Daniel Tseytlin,2 Hope Kincaid,3 Sharon Maynard1© 2015 Lehigh Valley Health NetworkAbstractReferences:1.	 	Schiffl	H:	Renal	recovery	from	acute	tubular	necrosis	requiring	renal	replacement	therapy:	A	prospective	study	in	critically	ill	patients.	Nephrol Dial Transplant	21:	1248–1252,	2006.		2.	 	Ali	T:	Incidence	&	outcome	in	acute	kidney	injury;	a	comprehensive	population	based	study.	JASN	2007.3.	 	Harel	Z,	Bell	C,	et	al.	Predictors	of	progression	to	chronic	dialysis	in	survivors	of	severe	acute	kidney	injury:	a	competing	risk	study.	BMC Nephrology	2014,	15:114.4.	 	Bellomo	R,	Ronco	C,	Kellum	JA,	et	al.	Acute	renal	failure	-	definition,	outcome	measures,	animal	models,	fluid	therapy	and	information	technology	needs:	the	Second	International	Consensus	Conference	of	the	Acute	Dialysis	Quality	Initiative	(ADQI)	Group.INTRODUCTION:According	to	RIFLE	criteria,	ESRD	is	defined	as	a	complete	loss	of	renal	function	or	need	for	renal	replacement	therapy	for	more	than	3	months.	Patients	who	develop	persistent	dialysis-dependent	acute	kidney	injury	(AKI-HD)	are	at	a	significant	risk	of	developing	irreversible	renal	failure	that	requires	long-term	dialysis.	While	previous	studies	showed	that	less	than	10%	of	AKI-HD	patients	progressed	to	end-stage	renal	disease	(ESRD)1,2,3	certain	populations	of	people	are	at	higher	risk.	The	need	for	chronic	dialysis	was	predicted	by	pre-existing	kidney	disease,	hypertension	and	higher	comorbidity	index	scores	in	a	recent	study	by	Harel,	et	al.3	OBJECTIVE:We	sought	to	describe	clinical	characteristics	and	outcomes	in	patients	with	persistent	dialysis-dependent	acute	kidney	injury	at	the	time	of	hospital	discharge	which	may	aid	in	more	timely	identification	of	patients	who	progress	to	ESRD.		The	results	of	this	study	may	help	generate	hypotheses	regarding	prediction	of	ESRD	from	clinical	variables	in	this	population.METHODS:This	was	a	retrospective,	descriptive	study	of	patients	enrolled	in	the	Lehigh	Valley	Health	Network	Subacute	Dialysis	Program	between	the	program’s	inception	in	October	2012	and	July	2014.	RESULTS:Of	55	patients	enrolled	in	the	program,	26	(47.3%)	recovered	renal	function	and	29	(52.7%)	developed	ESRD.	Clinical	characteristics	of	these	patients	are	shown	in	the	Figures	1-5.		The	median	duration	of	dialysis	in	the	renal	recovery	group	was	3.5	weeks.		Although	75%	of	patients	who	recovered	renal	function	did	so	by	5.1	weeks,	2	out	of	26	(7.7%)	recovered	more	than	3	months	after	dialysis	initiation.	CONCLUSIONS:This	hypothesis-generating	study	indicates	that	patients	who	did	not	recover	renal	function	were	older	and	had	higher	serum	creatinine	at	baseline,	at	hospital	admission	and	at	dialysis	initiation	than	those	who	recovered	renal	function.		While	there	was	a	decrease	in	serum	creatinine	from	week	3	to	week	4	in	patients	with	renal	recovery,	there	was	an	increase	for	those	who	did	not	recover.	More	patients	who	did	not	recover	renal	function	had	hypertension,	heart	failure	and	CAD.	Additionally,	more	patients	who	had	ATN	recovered	renal	function,	while	all	patients	with	multiple	myeloma	did	not.	Future	hypothesis-testing	studies	would	be	beneficial	in	further	exploring	whether	or	not	these	clinical	characteristics	may	be	used	to	predict	which	patients	are	likely	to	recover	renal	function	and	which	are	not.	Figure 2. Baseline	Creatinine	Distributionby	GroupFigure 1. Age	Distributionby	GroupFigure 3. Distribution	of	Creatinine	at	Time	of	DialysisInitiation	by	GroupFigure 4. Distribution	of	Creatinine	3	Weeks	After	Dialysis	Initiation	by	GroupFigure 5. Average	Change	in	Serum	Creatinine	Over	Time	by	GroupFigure 6. Percentage	of	Patients	With	Each	Comorbidity	by	GroupFigure 7. Etiology	of	Acute	Kidney	Infection	by	GroupContact: Daniel	Tsetylin,	DO.	Email:	Daniel.Tseytlin@LVHN.org

Outcomes in Patients with Persistent Dialysis-Dependent Acute Kidney Injury

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Outcomes in Patients with Persistent Dialysis-Dependent Acute Kidney Injury

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