Recovery After Dialysis-Requiring Acute Kidney Injury
Recovery After Dialysis-Requiring Acute Kidney Injury
The Recovery After Dialysis-Requiring Acute Kidney Injury (RAD-AKI) Pilot Study is a 2-arm
 randomized clinical trial of hospitalized patients with dialysis-requiring acute kidney
 injury (RAD-AKI), comparing conventional thrice-weekly intermittent hemodialysis dialysis
 (control) to a "conservative dialysis strategy" in which hemodialysis is not continued unless
 specific metabolic or clinical indications for RRT are present. The overall hypothesis is
 that the current practice of thrice-weekly acute intermittent hemodialysis for AKI-D masks
 evidence of renal recovery and may actually delay or preclude recovery. The primary objective
 of this pilot study is to assess the safety and feasibility of the proposed intervention and
 study design.
The recent landmark Artificial Kidney Initiation in Kidney Injury (AKIKI) trial showed that a
 delayed strategy for RRT initiation among patients with incident stage 3 AKI - in which RRT
 was delayed unless specific metabolic or clinical indications for RRT were present - was safe
 and averted the need for RRT in nearly half of the critically ill participants, in comparison
 to an early RRT initiation strategy. The hypothesis for this study is: for prevalent patients
 with established AKI-D, a conservative dialysis strategy - in which hemodialysis is not
 continued unless specific metabolic or clinical indications for RRT are present - will
 shorten time to RRT-independence and improve the likelihood of renal recovery.

 The RAD-AKI Pilot Study is a 2-arm randomized clinical trial of hospitalized patients with
 dialysis-requiring acute kidney injury (RAD-AKI) that will compare conventional thrice-weekly
 intermittent hemodialysis dialysis (control) to a "conservative dialysis strategy." The
 primary objective of this pilot study is to assess the safety and feasibility of the proposed
 intervention and study design.
Inclusion Criteria:

 -  Adult inpatients with AKI-D due to acute tubular necrosis who have already initiated
 renal replacement therapy

 -  If initiated on CRRT, patients will be eligible only if they have already tolerated 1
 intermittent hemodialysis (IHD) session at the research site.

 -  If transferred from an outside hospital, eligible patients must have tolerated 1 IHD
 session at the research site prior to enrollment.

 -  Not requiring vasopressor support

 -  Not intubated and not having a supplemental oxygen requirement of >5 L/min via nasal
 cannula

 -  Treating MDs (nephrology and primary team attendings) and patient (or legally
 authorized representative) consent to enrollment

 Exclusion Criteria:

 -  Diagnosis of end-stage renal disease (ESRD) or chronic dialysis prior to
 hospitalization

 -  Baseline estimated glomerular filtration rate (eGFR) <15 mL/min/1.73m2

 -  Liver transplant unit patients

 -  Patients who underwent kidney transplantation during index hospitalization

 -  Cause of AKI-D is complete nephrectomy

 -  Current pregnancy