Acute kidney injury (AKI) is one of the most common and life-threatening complications in hospitalized patients.
The most severe form of AKI can require hemodialysis and is associated with an increased risk of death. Those who survive may face the possibility of long-term dialysis dependency.
Previous studies have examined when and how to start dialysis, but none have focused on the best way to stop it. Once stable, patients are often put on a scheduled dialysis regimen, usually three treatments a week, until they show obvious signs of recovery.
To test whether conventional, three-times-a-week dialysis may delay or impede recovery of kidney function, researchers at Vanderbilt Health and three other centers compared conventional dialysis to a conservative dialysis strategy.
In the conservative strategy, patients received dialysis only when specific metabolic or clinical indications were met or were felt to be indicated by the treating clinical teams.
Results of the study, reported in the Journal of the American Medical Association, suggest that the conservative approach to dialysis may significantly enhance kidney recovery, although the researchers recommended a larger study to validate the findings.
Edward Siew, MD, MSCI, professor of Medicine in the Division of Nephrology and Hypertension at Vanderbilt Health, helped design and supervise the randomized clinical trial.
The appropriately named Liberation from Acute Dialysis (LIBERATE-D) study was co-led by researchers at the University of California San Francisco, Washington University School of Medicine in St. Louis and Intermountain Health in Salt Lake City.
Between January 2020 and March 2025, 221 patients with dialysis-requiring AKI were randomly assigned to either a conventional dialysis control group (three-times-a-week dialysis) or the conservative dialysis intervention strategy.
The study showed that 64% of participants who underwent the conservative strategy recovered kidney function, defined as being alive and not receiving dialysis for at least 14 consecutive days by the time of hospital discharge, compared to 50% of those in the control group.
Patients in the conservative dialysis group also received fewer dialysis sessions per week (1.8 vs. 3.1 sessions in the conventional group), had significantly more consecutive dialysis-free days by day 28 (21 vs. 5 days), and experienced dialysis-associated hypotension less often (69 vs. 97 hypotensive events).
“While hemodialysis can be lifesaving, our findings indicate that in stable patients with AKI, a one-size-fits-all approach of three-times-a-week dialysis may mask signs of or even slow recovery of kidney function in some patients,” Siew said.
“We hope the findings provide support for a daily careful assessment of whether a patientneeds dialysis that can be both beneficial and reduce the burden of unnecessary dialysis treatments.”
The study was funded in part by National Institutes of Health grants R01DK122797, K23DK128605 and K23DK139456.
