Kidney recovery in patients discharged to an acute rehabilitation facility with acute kidney injury requiring hemodialysis

Background: Patients with acute kidney injury requiring renal replacement therapy (AKI-RRT) are at risk of adverse outcomes. Little is known about the incidence of AKI-RRT recovery following hospital discharge. We examine AKI-RRT recovery in hospital survivors discharged to a long-term acute care hospital (LTACH) with need of hemodialysis (HD) for AKI. Materials and methods: Single-center, retrospective cohort study of patients who were hospitalized (08/2015 - 04/2018), suffered from AKI-RRT, and were discharged to an affiliated LTACH with need for HD. Kidney recovery was defined as the patient being alive and no longer requiring HD. Results: 41 patients were included. Mean (SD) age was 61.3 (9.7) years, 63.4% were male, and 90.2% white. At the time of discharge from LTACH, 27 (65.8%) patients had survived and had recovered kidney function (kidney recovery group), 7 had been discharged on HD, and 7 had died (no kidney recovery group, n = 14, 34.2%). In adjusted models, the presence of anemia was associated with a 91% decreased odds of kidney recovery at LTACH discharge. Each additional HD session during LTACH stay had an 18% decreased odds of kidney recovery at LTACH discharge, and each episode of intradialytic hypotension had a 20% decreased odds of kidney recovery at the end of the observation period (median follow-up of 19.0 months). Conclusion: Almost 2/3 of AKI-RRT patients discharged to an affiliated LTACH with ongoing HD need recovered kidney function. Anemia and the number of HD sessions and intradialytic hypotension episodes were associated with kidney recovery. Future studies should focus on developing risk-stratification tools for kidney recovery and determining best practices to promote recovery in this susceptible population.