Implications of Acute Kidney Injury Requiring Dialysis Versus End-Stage Kidney Disease Status

More than 20% of patients receiving dialysis at in-center hemodialysis facilities initiate dialysis for acute kidney injury requiring dialysis (AKI-D) rather than end-stage kidney disease (ESKD). The transition from AKI-D to ESKD status is important to reorient clinical efforts from short-term monitoring for recovery to equally important long-term goals of establishing permanent dialysis access and planning for kidney transplant. The timing of this transition is highly variable and determined by the treating nephrologist. Because of numerous subtle policy differences, the implications of transitioning a patient receiving dialysis for AKI-D to ESKD status can be complex and far-reaching. Here, we aim to describe the financial and nonfinancial implications of the AKI-D-to-ESKD status transition. Clinicians and policymakers alike may be able to improve the care of this vulnerable patient population through a better understanding of these implications. We conclude with policy recommendations to address disincentives to optimal care.