Supported Research

Lay Summary

Acute kidney injury (AKI) is a rapid decline in kidney function, and it is a common complication for patients in the hospital. Dialysis is an important treatment for patients with severe AKI, but we do not know which patients are likely to recover after severe AKI that requires dialysis or how to increase the likelihood of kidney recovery. This study’s goal is to identify characteristics in patients that make kidney recovery more likely and test the feasibility of a new dialysis strategy to promote kidney recovery in patients with AKI who remain on dialysis after the initial illness has resolved.

This study will have 2 parts. In Part 1, patients with AKI who remain on dialysis at 5 hospitals in Ontario will be asked if the research team can collect health information for up to 6-months. This information will be collected through the medical record, and the only extra tests needed are weekly blood tests and urine collection. In Part 2, the same patient population will be asked if they are also willing to be randomized, like the flip of a coin, to a new dialysis strategy (based on a standard protocol of expert opinion and best practices) or usual care (based on the patient doctor’s opinion). Dr. Silver will follow the progress of all patients until they recover enough kidney function to stop dialysis or 6-months after the first dialysis session.           

Results from Part 1 will help determine which patient characteristics (like age, heart disease, and urine output) can predict which patients still on dialysis are likely to recover kidney function. Results from Part 2 will help determine if the new dialysis strategy is acceptable and followed by patients and healthcare providers, as well as which parts of the strategy work and which ones should be changed. Dr. Silver will also securely link the collected data to government databases, so that he can study other long-term outcomes (like death and hospitalizations).

This research will be the first to study a group of patients with the potential to recover kidney function after severe AKI, as well as the first to test a dialysis strategy to promote kidney recovery. These results will help design patient-centered decision-making tools to ease anxiety for patients likely to recover and speed chronic dialysis planning for patients less likely to recover. It will also make ongoing testing of potential recovery strategies easier because they can be targeted at the patients most likely to get off dialysis. In this way, patients with AKI still on dialysis can begin to receive more accurate information about their prognosis and personalized care.