Kidney Week 2025 Annual Meeting-Dialysis-Dependent AKI: Therapies for Kidney Recovery and Improving Cardiovascular Outcomes

Video Transcription

Video Summary

This ASN Kidney Week session focused on dialysis-dependent acute kidney injury (AKI-D): who develops it, what happens after discharge, how dialysis delivery affects recovery, and how to improve post-AKI outcomes.<br /><br />Dr. Javier Neyra reviewed epidemiology and recovery: AKI-D occurs in ~1–2% of hospitalized patients (higher in ICUs and sepsis). Mortality is high early, but among survivors, kidney recovery is common—often within the first 30–60 days, then declines. Risk factors for nonrecovery include older age, comorbidities, lower baseline eGFR, transfusions, and hemodynamic instability. He emphasized “dialytrauma,” especially intradialytic hypotension and reduced kidney perfusion, and discussed signals that CRRT initiation (vs intermittent HD), lower intensity dosing, careful ultrafiltration targets, and improved CRRT process metrics may support recovery. Innovations include integrating device data to detect downtime and using hemodynamic-guided fluid removal protocols. Preventing complications (notably hypophosphatemia) and emphasizing de-escalation strategies were highlighted.<br /><br />Dr. Ian McCoy summarized sobering outcomes after AKI-D: ~50% die in-hospital/within 90 days in some cohorts; many survivors remain dialysis-dependent. Recovery markedly improves survival and reduces hospitalizations. He reviewed dialysis-related harms affecting heart (myocardial stunning), brain (increased intracranial pressure, reduced cerebral blood flow, cognitive decline), and gut (mesenteric ischemia linked to low absolute BP). Trials increasingly suggest “more dialysis” can worsen hypotension and delay recovery.<br /><br />Dr. Anita Vijayan addressed post-discharge transitions, emphasizing poor information transfer, need for warm handoffs, outpatient protocols tailored to AKI-D (no fixed dry weight, urine output tracking, frequent reassessment), and regulatory changes enabling outpatient and home dialysis for AKI-D. <br /><br />Dr. Steven Menez discussed preventing AKI-to-CKD progression via risk stratification, biomarkers, post-AKI clinics, and emerging targeted therapies (including potential roles for SGLT2 inhibitors), with ongoing trials testing structured post-AKI care.

Asset Subtitle

Moderator(s): Bethany Birkelo, Belbina Pereira

Presentation(s):

Manifestations Leading to AKI Dialysis Dependency - Javier Neyra
Effects of Dialysis-Dependent AKI on Cardiovascular Outcomes - Ian McCoy
Post-AKI Care: Patient and Population Health Perspectives - Anitha Vijayan
Halting Progression of CKD After AKI: Is There a Role for Novel Therapies? - Steven Menez

Meta Tag

Date 11/9/2025

Pathway 1 Dialysis

Pathway 2 AKI and Critical Care

Session ID 507328

Keywords

dialysis-dependent acute kidney injury

AKI-D epidemiology

kidney recovery after AKI-D

post-discharge outcomes AKI-D

intradialytic hypotension

dialytrauma

continuous renal replacement therapy

intermittent hemodialysis

ultrafiltration targets

CRRT process metrics

hemodynamic-guided fluid removal

hypophosphatemia prevention

myocardial stunning

post-AKI care transitions

AKI-to-CKD progression