Clinical Trials Targeting Recovery and Postdischarge Care in Dialysis for Acute Kidney Injury

Receipt of dialysis for acute kidney injury is common and increasing. For patients still actively receiving dialysis, it is possible that the dialysis procedure itself decreases the likelihood of kidney recovery or confounds recognition that recovery has occurred. Accordingly, 2 ongoing trials are testing hypotheses that dialysis prescriptions to minimize dialysis-induced ischemia and/or standardize dialysis discontinuation will increase the likelihood of renal recovery compared to usual care. These will be some of the first clinical trials to focus on hospitalized patients during the recovery phase of their acute illness. Meanwhile, clinical trials in the postdischarge population have found that less than 30% of patients choose to enroll when interventions require in-person nephrology follow-up, suggesting more flexible and pragmatic follow-up pathways are needed. Key considerations for future trials in dialysis for acute kidney injury will include recruiting patients at the right time in their clinical course during the window between acute kidney injury development and recovery or death, as well as providing interventions/follow-up over great distances and in multiple care settings. Testing different care strategies in this rigorous manner may eventually help reduce variation in care across centers and identify evidence-based practices that promote kidney recovery in dialysis for acute kidney injury.