Newswise — Washington, DC (February 27, 2025)—The American Society of Nephrology (ASN) today released the ASN Kidney Health Guidance on the Outpatient Management of Patients with Dialysis-Requiring Acute Kidney Injury in the Journal of the American Society of Nephrology (JASN). Acute kidney injury (AKI) is a common and serious complication experienced by hospitalized adults and pediatric patients. Severe cases of AKI may require in-hospital hemodialysis (AKI-D). While recent studies have shown improving hospital mortality rates for patients with AKI-D, up to 30% of survivors require dialysis treatment after discharge from the hospital. The new ASN Kidney Health Guidance (KHG) was developed to address the particular care needs of patients with AKI-D in the outpatient setting who have significantly higher risk for developing permanent dialysis dependence, cardiovascular disease, rehospitalization, and death.
Reporting from the United States Renal Data System (USRDS) shows that the number of patients with AKI receiving outpatient hemodialysis increased from 6,400 individuals in 2017 to a peak of 11,964 in 2020. Most patients with AKI-D receive treatment at outpatient facilities designed to provide long-term dialysis care to individuals with end stage kidney disease (ESKD). While numerous regulatory and policy initiatives have been implemented to facilitate outpatient care of patients with AKI-D, significant gaps remain. Notably, patients with AKI-D often follow the protocol used for people on long-term dialysis despite significant pathophysiological differences between the two. An ASN working group of kidney care experts, including adult and pediatric nephrologists, social workers, pharmacists, and advanced practice nurses, all with experience caring for people with AKI -D, developed the guidance for AKI-D–specific considerations based on current evidence and expert opinion. The guidance is intended to inform the interdisciplinary dialysis care team and should not preclude clinical judgment.
“For people with AKI-D, one of the most important outcomes is to recover adequate kidney function to be liberated from dialysis,” said Kathleen Liu, MD, chair, KHG Oversight Committee. “While outpatient facilities provide excellent long-term dialysis care, we must help ensure that every patient receives the optimal care for their individual circumstances. This new guidance will help facilitate the transition from the hospital setting to outpatient care for people with AKI-D and help care teams identify the early signs of possible recovery in order to promote a life free of kidney disease and its consequences.”
The Kidney Health Guidance highlights the importance of individualized dialysis care for people with AKI-D, including the close coordination of care among patients, caregivers, dialysis care teams, nephrologists, and other health care professionals. The guidance also outlines recommendations for future research and policy priorities to further inform best practices to optimize outcomes for patients with AKI-D.
About ASN
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality care for patients. ASN has nearly 22,000 members representing 141 countries. For more information, visit www.asn online.org and follow us on Facebook, X, LinkedIn, and Instagram.
About JASN
As the flagship journal of the American Society of Nephrology, the Journal of the American Society of Nephrology (JASN) has been published monthly since July 1990. JASN publishes high-impact original research to advance the understanding and treatment of kidney diseases, including physiology, pathobiology, and person-centered care. JASN also publishes a variety of featured content, including the ASN Kidney Health Guidance, which is intended to assist clinicians with the interpretation and integration of evolving scientific evidence into practice by addressing key questions facing the kidney care team. For more information on JASN, visit journals.lww.com/jasn.
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