Weaning hospitalized patients from dialysis may restore kidney function

Weaning patients with acute kidney injury (AKI) from dialysis while they are still hospitalized may save them from remaining on the treatment for the rest of their lives, according to a new study led by UC San Francisco. 

Instead, some patients who may have the potential to recover kidney function while hospitalized are transferred to outpatient centers with fewer specialty doctors and less intensive monitoring, where subtle signs of recovery may be overlooked. 

Although dialysis is needed to support patients with low kidney function, paradoxically it can delay or even prevent the kidneys' natural ability to recover from AKI. Dialysis slows kidney recovery by dropping blood pressure and reducing blood and oxygen flow, causing additional damage that may lead to irreversible kidney failure. 

"Patients with AKI go from seeing a nephrologist every day or every other day while they are hospitalized, to once a week, or as infrequently as once a month after they transfer to outpatient dialysis centers," said senior author Chi-yuan Hsu, MD. 

"Stopping dialysis can be risky, so it's natural for nephrologists to be conservative and continue with regularly scheduled dialysis unless recovery is very obvious." 

The number of people on dialysis continues to swell, due to chronic conditions like diabetes, that can cause irreversible end-stage kidney disease. These patients require lifelong dialysis unless they receive a donated kidney. But up to 1 in 4 new referrals at dialysis centers have AKI, triggered by conditions like sepsis, heart failure, trauma to the kidneys, or serious surgical complications. An estimated 50% of patients with AKI die in the hospital. Of those who survive, temporary dialysis is the goal. 

In the study, 220 hospitalized patients, whose average age was 56, were randomly divided into two groups. One group received dialysis three times a week until there were clear indications that their kidney function had improved. The second group only received dialysis when they absolutely needed it. 

At discharge, 50% of those on conventional dialysis recovered kidney function and no longer required dialysis. But 64% of those who received minimal dialysis reached this milestone. The researchers saw no differences in adverse outcomes between the two groups. 

Generally, dialysis centers do not have the infrastructure to support our weaning intervention. This would include daily assessments of patients' labs and vital signs. Larger studies are needed to confirm our findings, and additional studies would be needed to determine how weaning can be adapted for patients with AKI at outpatient dialysis centers." 

Kathleen Liu, MD, PhD, first author of the paper