Challenges in the Care of Patients with AKI Receiving Outpatient Dialysis: AKINow Recovery Workgroup Report

Abstract

Background: Up to one-third of survivors of acute kidney injury that required dialysis (AKI-D) during a hospitalization remain dialysis dependent at hospital discharge. Of these, 20 to 60%, depending on the clinical setting, eventually recover enough kidney function to stop dialysis and the remainder progress to end-stage kidney disease. Methods: To describe the challenges facing those still receiving dialysis on discharge, the AKINOW Committee conducted a group discussion composed of 59 participants including physicians, advanced practitioners, nurses, pharmacists, and patients. The discussion was framed by a patient who described gaps in care delivery at different transition points and miscommunication between care team members and the patient. Results: Group discussions collected patient perspectives of: 1) being often scared and uncertain about what is happening to and around them and 2) the importance of effective and timely communication, a comfortable physical setting, and attentive and caring healthcare providers for a quality healthcare experience. Provider perspectives included: 1) the recognition of the lack of evidence-based practices and quality indicators, the significant variability in current care models, and the uncertain reimbursement incentives focused on kidney recovery and 2) the urgency to address communication barriers among hospital providers and outpatient facilities. Conclusions: The workgroup identified key areas for future research and policy change to: 1) improve communication among hospital providers, dialysis units and patients/care partners; 2) develop tools for risk-classification, sub-phenotyping and augmented clinical decision support; 3) improve education to providers, staff, and patients/care partners; 4) identify best practices to improve relevant outcomes; 5) validate quality indicators; and 6) assess the impact of social determinants of health on outcomes. We urge all stakeholders involved in the process of AKI-D care to align goals and work together to fill knowledge gaps and optimize the care to this highly vulnerable patient population.