Kidney Week 2025 Annual Meeting-Guidance for Outpatient Dialysis for AKI: How to Optimize Outcomes

Video Transcription

Video Summary

This session focused on how to optimize outcomes for patients with acute kidney injury requiring dialysis (AKI-D) after hospital discharge, emphasizing that outpatient dialysis units increasingly care for these patients but often treat them like end-stage kidney disease (ESKD) patients despite different goals and trajectories.<br /><br />Dr. Sada Babroudi reviewed epidemiology and policy. AKI occurs in roughly 20–30% of hospitalized adults globally, with only a small fraction requiring dialysis. In the U.S., CMS policy changes strongly shaped outpatient AKI-D care: a 2012 Medicare clarification restricted outpatient AKI-D dialysis, the 2017 Trade Preferences Extension Act restored coverage, and a 2025 rule allows home dialysis reimbursement for AKI-D. Misclassification of AKI-D as ESKD has declined but persists. Among AKI-D patients starting outpatient dialysis, about 30% recover (usually within 3 months), ~50% remain dialysis-dependent, and ~20% die within 6 months. Recovery is less likely with older age, comorbid CKD/heart disease, high ultrafiltration rates, intradialytic hypotension, and social risk burden; disparities by sex and race require further study.<br /><br />Dr. Ian McCoy emphasized avoiding “dialytrauma,” especially intradialytic hypotension, to promote recovery. Practical strategies include permissive higher blood pressures (often tolerating systolic up to ~180 in appropriate patients), minimizing ultrafiltration needs with sodium/fluid restriction and continued diuretics, cooler dialysate, and considering less frequent or tapered dialysis with close monitoring (weekly timed urine collections and labs) and earlier trials of discontinuation.<br /><br />Dr. Adesu highlighted pharmacists’ role: nephrotoxin stewardship, dose adjustment during changing renal function, medication education, and timely reinitiation of evidence-based therapies (ACEi/ARB, possibly SGLT2 inhibitors, and statins when indicated) based on observational data suggesting mortality benefits.<br /><br />Dr. Mike Hung outlined research and policy priorities: evaluating home dialysis for AKI-D, defining best weaning/stop criteria, improving anemia and mineral-bone management evidence, and creating regulatory/data systems and quality measures that distinguish AKI-D from ESKD to support tailored care and reduce unnecessary dialysis.

Asset Subtitle

Moderator(s): Emaad Abdel-Rahman, Erin Barreto

Presentation(s):

Epidemiologic Trends and the Current State of Outpatient Dialysis for Patients with AKI - Seda Babroudi
Wake Up the Kidneys! Fluid and BP Management in AKI Requiring Dialysis - Ian McCoy
Partnering with Pharmacists to Optimize Management of AKI Requiring Dialysis - Linda Awdishu
The Path Forward: Research and Policy Priorities for Outpatient Care of AKI Requiring Dialysis - Michael Heung

Meta Tag

Date 11/8/2025

Pathway 1 AKI and Critical Care

Pathway 2 Dialysis

Session ID 507313

Keywords

acute kidney injury requiring dialysis (AKI-D)

post-discharge outpatient dialysis care

dialysis recovery and weaning

CMS Medicare policy changes for AKI-D

Trade Preferences Extension Act 2017

home dialysis reimbursement rule 2025

AKI-D misclassification as ESKD

dialytrauma prevention

intradialytic hypotension management

ultrafiltration rate minimization

permissive hypertension strategy

weekly timed urine collections monitoring

nephrotoxin stewardship by pharmacists

ACE inhibitor/ARB reinitiation

SGLT2 inhibitors and statin therapy in AKI-D