ASN Kidney Health Guidance on the Outpatient Management of Patients with Dialysis-Requiring Acute Kidney Injury
Authors: Anitha Vijayan, Michael Heung, Linda Awdishu, Seda Babroudi, Gopa B. Green, Lisa Koester, Ian E. McCoy, Shina Menon, Paul M. Palevsky, Lorri A. Proctor, David T. Selewski, Sarah Struthers
Journal: Journal of the American Society of Nephrology (2025)

Introduction AKI is a common and serious complication among hospitalized adult and pediatric patients,1 with severe cases requiring KRT. Although recent studies have shown improving hospital mortality rates for patients with dialysis-requiring AKI (AKI-D),2 up to 30% of AKI-D survivors will require dialysis beyond discharge.3 Data from the United States Renal Data System (USRDS) demonstrate a marked increase in patients with AKI receiving outpatient hemodialysis in ESKD facilities, from 6400 individuals in 2017 to a peak of 11,964 in 2020.4 After hospitalization, patients with AKI-D who are dialysis dependent at discharge remain at significantly increased risk of adverse outcomes, including CKD, permanent dialysis dependence, cardiovascular disease, rehospitalization, and death.5 In the United States, despite numerous regulatory and policy initiatives aimed at facilitating outpatient care of patients with AKI-D, there remain significant gaps in care.6 A paucity of high-level evidence to guide management has resulted in wide variability in clinical practices. AKI survivors report inconsistent care in outpatient dialysis facilities, and despite significant pathophysiological differences, their care often mirrors that of the patient with ESKD.7,8 Recognizing the significant vulnerability of this population, the American Society of Nephrology (ASN) Kidney Health Guidance (KHG) oversight committee convened a multidisciplinary expert workgroup to address the need for clinical guidance in the care of patients with AKI-D who continue to require dialysis after hospital discharge. This guidance does not address the management of patients with AKI-D who achieve dialysis independence before discharge from the hospital. In addition, while the clinical guidance in this document may be applicable globally, some of the regulatory challenges and suggestions are primarily meant for patients dialyzing in outpatient facilities in the United States. Methodology Workgroup member expertise included adult and pediatric nephrology, social work, pharmacy, and advanced practice nursing, all with direct experience caring for patients with AKI-D in the outpatient setting. Initial workgroup meetings focused on formulation of key clinical questions to guide a structured evidence review. An external expert conducted the literature review, and relevant studies were reviewed by the workgroup. The workgroup followed an iterative, modified Delphi process to achieve consensus on clinical guidance practice points. This guidance reflects the current evidence and key opinions from this expert workgroup plus input from patients who have experienced outpatient AKI-D care and is intended for all members of the interdisciplinary dialysis care team. The guidance should not preclude clinical judgment and must be applied individually accounting for patient preferences, comorbidities, and other factors. Determining Prognosis for Posthospitalization Recovery of Kidney Function One of the most important outcomes for patients with AKI-D is recovering adequate kidney function to achieve liberation from dialysis. Nephrologists have an important responsibility to identify improvements in kidney function as early as possible and to deliver care that optimizes chances of recovery (Figure 1: Outpatient Management of AKI-D). The term dialytrauma was introduced initially in the critical care literature to describe complications—including hypotension and distant organ injury—associated with hemodialysis or continuous KRT.9,10 We believe this term remains highly relevant for patients with AKI-D because dialytrauma caused by ongoing dialysis may decrease the chances of achieving recovery. As such, a first do no (kidney) harm approach is critical when it comes to dialysis prescription for AKI-D and serves as a guiding principle for this document.Figure 1: Clinical care pathway for the outpatient management of patients with AKI-D. *Evidence of recovery includes increasing UOP, increasing measured CrCl, decreasing IDWG, declining trend in prehemodialysis Cr. **Continuing monitoring should include ongoing patient education, resetting expectations and GOC discussions. Table 2 (recovery phenotypes), Table 3 (warm handoffs), and Table 4 (key practice points) should be referenced for detailed guidance. AKI-D, dialysis-requiring AKI; GOC, goals of care; HD, hemodialysis; IDWG, interdialytic weight gain; UOP, urine output.AKI-D is a heterogeneous syndrome and requires significant individualization of management in the outpatient dialysis setting. We present guidance that varies depending on a patient's clinical characteristics (i.e., phenotype), with the most important phenotypic distinction being the likelihood of kidney function recovery. Previous data suggest that outpatient recovery of kidney function ranges from 20% to 60% of patients.3 Recent USRDS data found that at 6 months after discharge, 31% of patients with AKI-D achieved dialysis independence.4 Unfortunately, predicting which patients will recover remains challenging. Studies have developed predictive models for AKI-D recovery in the outpatient setting,11–13 but these tools are hampered by modest discrimination and limited external validation. Nonetheless, certain risk factors can help inform clinical prognostication and management (Table 1).14 Table 1 - Patient characteristics associated with kidney function recovery from dialysis-requiring AKI Patient Characteristic Effect on Likelihood of Recovery Baseline kidney function11,12,15–17 eGFR Increases with higher baseline eGFR Albuminuria Decreases with greater albuminuria Age12,13,16 Decreases with older age Comorbidities Diabetes mellitus12 Decreases with increasing comorbidity burden and presence of specific comorbidities Chronic liver disease12 Heart failure13,16,17 Comorbidity index11,15 Severity of AKI Duration of dialysis before discharge11 Decreases as duration of dialysis increases The strongest predictive factor for AKI recovery is baseline kidney function. Most patients with normal (eGFR >60 ml/min per 1.73 m2) prehospitalization kidney function will eventually recover to dialysis independence. However, even among patients with stage 4 CKD, up to 20%–30% of patients will experience recovery.12,18,19 Thus, any single factor is inadequate in assessing the likelihood of recovery with certainty. Because of poor predictive accuracy, it is appropriate to err on the side of assuming that most patients will recover, and therefore, all patients should initially receive AKI-D–specific individualized care (versus protocolized care typical for patients on long-term maintenance dialysis). For patients with a high likelihood of recovery of kidney function, it is appropriate to maintain this approach for at least 90 days after discharge. Conversely, for patients with low likelihood for recovery, earlier designation of ESKD diagnosis may be appropriate so as not to delay care (e.g., vascular access placement or transplant evaluation). In addition, for patients with AKI-D and significant comorbidities (such as severe frailty, advanced heart failure, and advanced malignancy), nephrologists should facilitate shared goals-of-care discussions, including advanced care planning and palliative care options.20Table 2 presents a framework for applying the practice points presented in this document, on the basis of recovery phenotype. Table 2 - Framework for approach to management of patients with dialysis-requiring AKI in the outpatient setting on the basis of likelihood of renal recovery Estimated Likelihood for Recovery of Kidney Function Example Scenarios—At Point of Discharge or Outpatient Dialysis Intake Approach High (>30%) recovery phenotype • All patients with baseline eGFR >60• Younger patients (<55 yr) with baseline CKD but minimal comorbidity burden (e.g., no liver or heart failure)• Patients with short duration of dialysis dependence <30 d • Care focused on promoting kidney function recovery• Close monitoring for recovery for at least 90 d after discharge Moderate (10%–30%) recovery phenotype • Patients with baseline CKD and limited comorbidity burden• Patients with baseline CKD and intermediate duration of dialysis dependence (30–90 d) • Care focused on promoting kidney function recovery• Close monitoring for recovery for at least 30–60 d after discharge Low (<10%) recovery phenotype • Patients with 3 or more of the following ○ Advanced baseline CKD (eGFR <15 or eGFR <30 with A3 albuminuria) ○ Older age (>75 yr) ○ Significant comorbidities (decompensated liver or heart failure) ○ Prolonged duration of dialysis dependence (>90 d) • Initial care focused on promoting kidney function recovery• Consideration for early (<30 d) transition to ESKD diagnosis with appropriate shift in management Transition of Care from Hospital to Outpatient Facility As a result of changes in Centers for Medicare & Medicaid Services policy, beginning in January 2017, dialysis care for US outpatients with AKI-D largely shifted from the inpatient setting and hospital-based dialysis centers to free-standing ESKD-certified facilities.6 Although this resulted in some benefits (e.g., reduced patient travel, reduced inpatient length of stay, and decreased pressure for early ESKD certification), concerns arose for unintended detrimental consequences potentially leading to lower likelihood of kidney recovery.21 As a starting point, we strongly suggest that hospital discharge planning include a warm handoff (i.e., direct, live communication between clinicians) to the outpatient nephrology and dialysis care team to ensure continuity of care and to set appropriate expectations on the basis of the kidney recovery phenotype. The accepting nephrologist should place AKI-D–specific orders, as dialysis prescription, laboratory studies, and nursing assessments should differ from standard ESKD protocols. Table 3 summarizes key elements for handoff from hospitalization to outpatient dialysis. Table 3 - Key elements for handoff from hospitalization to outpatient dialysis facility in patients with dialysis-requiring AKI Category Data Elements Hospitalization diagnoses • Date of hospital admission• Primary reason for hospitalization• Key secondary diagnoses• Inpatient procedures ○ Surgery ○ Angiography• Hospital course/complications ○ ICU stay ○ Acquired infections Baseline kidney status • Prehospitalization kidney function ○ Serum creatinine and eGFR (date) ○ Urine albumin-to-creatinine ratio (date)• Kidney disease history (if applicable) ○ Diagnosis ○ Duration ○ Prior treatment ○ Name of prehospitalization nephrologist Course of AKI • Etiology of AKI• Pre-KRT course• Hospital KRT management ○ Date of initial KRT ○ Initial KRT modality ○ Changes in KRT modality Comorbidities • Diabetes mellitus?• Heart failure?• Liver cirrhosis?• Active malignancy?• Hypertension?• Other? Discharge data • Daily UOP at time of discharge• Most recent chemistry panel (date and results)• Most recent prehemodialysis serum creatinine and BUN (date and results)• Most recent hemoglobin (date and results)• Most recent iron panel and ferritin (date and results)• Hepatitis B surface antigen/antibody, core antibody, and hepatitis C antibody (date and results)• Dialysis-related medications ○ Any IV iron or ESA use? ○ Any phosphate binders? Dialysis management at discharge • Current dialysis prescription• Most recent treatment flow sheets (up to three)• Access for dialysis• Dialysis tolerance (e.g., intradialytic hypotension)• Estimated volume status ○ Target end-dialysis weight ○ Most recent achieved end-dialysis weight• Recommendations for monitoring recovery of kidney function Prognosis/quality of life • Functional status• Discharge disposition ○ Home ○ Inpatient rehabilitation/skilled nursing facility• Nonrenal prognosis• Prognosis for recovery of kidney function• Any palliative or GOC discussion? ESA, erythropoiesis-stimulating agent; GOC, goals of care; ICU, intensive care unit; IV, intravenous; UOP, urine output. Accepting dialysis facilities must clearly distinguish patients with AKI-D from those with ESKD. Staff should receive education about differences in care for patients with AKI-D. As an example, some centers have developed specialized AKI-D care units (embedded in the traditional ESKD dialysis facility) focusing on individualized care.15,17 Unfortunately, despite higher complexity and monitoring needs in AKI-D, there are no changes in mandated staffing ratios for this population. Patients with AKI-D should be classified as unstable under Medicare's Conditions for Coverage standards for dialysis facilities 22 and thus undergo monthly Comprehensive Interdisciplinary Patient Assessments. We suggest adopting an AKI-D–specific care plan for these patients with additional focus from the interdisciplinary team (IDT) on clinical assessment, BP management, volume status, and weekly laboratory tests (see Supplement 1). Communication expectations between the nephrologist and other members of the IDT should be established upon admission, including frequency of meetings and AKI care plan–specific charting. The dietitian should clearly delineate AKI-specific dietary recommendations to account for posthospitalization nutritional deficits and changing requirements with recovery. Patient education on kidney function, potential complications of AKI, and CKD management is another critical aspect of comprehensive care. Direct communication with patients and their families must be prioritized to set expectations around potential signs and symptoms of recovery. Psychosocial Factors Patients with AKI-D often have poor health-related quality of life and need intensive psychosocial support.23 Psychosocial concerns are likely even greater with preexisting health disparities, such as lower health literacy or socioeconomic status. Financial stress may arise from patients becoming unemployed or underemployed during hospitalization, along with accrual of out-of-pocket health care expenses. Complicating this are varying rules of eligibility for benefit programs (e.g., short-term disability, Family Medical Leave Act, and health insurance coverage) that can be challenging to navigate. Unlike ESKD, a diagnosis of AKI-D does not qualify patients for Medicare coverage. Patients and their caregivers must be active participants in monitoring for kidney function recovery, dietary changes, and medication monitoring. Yet the cognitive load of incorporating these aspects of care can be overwhelming, especially during the vulnerable transition period to outpatient dialysis. Social workers, nurses, and dietitians are all instrumental in providing psychosocial support and identifying and connecting patients and families with appropriate financial, nutritional, and behavioral health resources and education. Care in the Outpatient Dialysis Facility The care in the outpatient dialysis unit is typically geared toward a patient with ESKD. AKI-D–specific care is ill defined, and in most centers, patients with AKI-D may receive protocolized care that is typically provided for patients on long-term maintenance dialysis (Figure 2). The following sections describe the key components of care in the outpatient dialysis facility that should be individualized for patients with AKI-D, as compared with the therapeutic plans and algorithms applied for patients with ESKD.Figure 2: Current care model for patients with AKI-D in the outpatient dialysis facility. Patients with AKI requiring dialysis often experience fragmented care without clear clinical guidance.Monitoring of Kidney Function Patients with AKI-D may have rapidly changing native kidney function as their AKI resolves or worsens. Therefore, patients with AKI-D require more frequent monitoring than the typical monthly laboratory tests.24 At minimum, weekly assessment of endogenous kidney function should be performed, particularly in patients with a moderate-to-high recovery phenotype and/or increasing urine output (UOP). These assessments should include measurement of predialysis serum creatinine, timed urine collection, and evaluation of BP, and volume status (Supplement 2 offers a nursing checklist to assist the staff in assessments of patients with AKI-D). Serum creatinine is affected by dialysis, muscle mass, and nutritional status, and therefore, eGFR equations should not be used to estimate residual kidney function.25 However, predialysis serum creatinine remains a useful and easily obtainable metric, and downward trends can be an indicator of recovering kidney function in nonoliguric patients; in the absence of increasing UOP, serum creatinine trends should be interpreted with caution because they may also result from illness-associated reduction in creatinine production or be masked by increased creatinine production during convalescence. Timed urine collections for urea and creatinine clearance in patients undergoing hemodialysis have historically been performed over a 44-hour period (i.e., interval between treatments) for logistical simplicity. However, this may underestimate kidney function because both urinary volume and solute clearance decrease sharply at the end of hemodialysis treatment and slowly recover during the interdialytic interval, presumably because of decreased renal perfusion during dialysis.26 Therefore, the optimal method may be a 12- or 24-hour urine collection immediately preceding a hemodialysis session with a prehemodialysis blood draw to calculate urea and creatinine clearance. The average of urinary urea and creatinine clearances provides the best estimate of residual kidney function.26 Modality of Dialysis The optimal modality of outpatient dialysis for individuals with AKI is uncertain. Until recently, the only outpatient option in the United States was in-center hemodialysis. However, the Centers for Medicare & Medicaid Services ESKD Prospective Payment System final rule for 2025 included a provision to extend coverage for Medicare patients with AKI to include home dialysis beginning January 2025.27 In the hospital setting, acute peritoneal dialysis (PD) has been associated with similar clinical outcomes when compared with hemodialysis.28–30 Experience from the coronavirus disease 2019 pandemic further provides optimism as to feasibility of PD as an outpatient option for AKI.31 PD may be associated with less intradialytic hypotension and therefore better recovery, although this has not been evaluated in clinical trials. However, home dialysis may be associated with increased patient and caregiver stress at an already challenging time. Importantly, the new rule also extends dialysis coverage to skilled nursing facilities, and assisted PD in this setting may offer a middle ground to overcome some barriers. At present, there is not enough experience to provide clinical practice points for PD in AKI-D, and our remaining guidance will focus on hemodialysis. Vascular Access The optimal hemodialysis vascular access for patients with AKI-D is usually a tunneled dialysis catheter in the internal jugular vein. If patients with underlying advanced CKD already have an existing arteriovenous fistula or graft, then that vascular access should be used instead. Placement of an arteriovenous access should be deferred until there is reasonable certainty that kidney function is unlikely to recover after adequate patient counseling. Timing of vascular access can be informed by estimating the recovery phenotype as presented earlier. Dose and Adequacy of Dialysis There are no rigorous data regarding the optimal dose of dialysis for a patient receiving outpatient dialysis for AKI. On the basis of the ATN study, in anuric patients, thrice-weekly hemodialysis with a single pool Kt/Vurea of 1.2–1.4 per treatment32 is the recommended dose of hemodialysis in AKI. More intensive dialysis has been associated with a reduced likelihood of kidney function recovery.33,34 Underdosing may risk hyperkalemia and metabolic acidosis, and less frequent dialysis and ultrafiltration may lead to volume overload. BP Management The optimal BP target in AKI-D is unknown. Observational studies in patients on long-term maintenance dialysis show a U-shaped relationship between predialysis systolic BP and mortality, with the lowest risk of systolic BPs of 140–179 mm Hg.35,36 Most AKI-D experts advocate for strategies to avoid hemodynamic instability because hypotension can negatively affect kidney recovery.37,38 As such, we suggest a more permissive approach to BP control to maintain predialysis systolic BP <180 mm Hg, although the optimal target is unknown and should be individualized to the patient. Volume Management In patients on maintenance dialysis, volume management is usually targeted at maximizing fluid removal to improve BP control and minimize symptoms of volume overload. This approach is, however, associated with increased risk of dialytrauma and intradialytic hypotension.19,39,40 Optimal volume management in patients with AKI-D may therefore require a degree of permissive hypervolemia to minimize the risk of hypovolemia-induced hypotension during dialysis.38 This approach must be balanced against avoiding volume overload severe enough to produce symptoms or precipitate hospitalization. Target weight and ultrafiltration goals in AKI-D are dynamic targets because patients may gain back weight lost during acute illness or potentially lose weight because of ongoing illness. Volume and BP assessments thus need to be conducted at every hemodialysis treatment and used to set fluid removal goals. In addition to a physical examination, patients should be asked about changes in urine production; caloric intake; sodium and fluid intake; physical conditioning; and any posthemodialysis symptoms, such as cramping, nausea, or vomiting. Nurses and other members of the IDT should be trained to participate in this monitoring and report important clinical changes (Supplement 2). In the ESKD population, higher ultrafiltration rates are associated with adverse outcomes, including hypotension, lower survival, and faster decline in residual kidney function.41 In patients with AKI-D, a more conservative approach to ultrafiltration has been associated with decreased risk of intradialytic hypotension,42 and we suggest that prescribed ultrafiltration should be <10 ml/kg per hour. In nonoliguric patients, loop diuretics can help control fluid accumulation and reduce ultrafiltration needs. High-dose loop diuretics are associated with less risk of intradialytic hypotension, presumably by increasing UOP and thereby decreasing the ultrafiltration goals per dialysis session.43 Loop diuretics are also associated with decreased risk of hospitalization in patients with incident ESKD.44 Extrapolating this information to AKI-D, we suggest a trial of furosemide 160 mg twice a day (or equivalent dose of torsemide or bumetanide) in all patients with AKI, except in those with already significant UOP and minimal interdialytic weight gain (<1 kg).45 In patients who remain oligoanuric, diuretics can be held until there is a reported or documented increase in UOP. Beyond reducing ultrafiltration rates, data are limited to guide best practices in reducing intradialytic hypotension. One of the most studied interventions in the ESKD population is cool dialysate, which reduces intradialytic hypotension46 and organ damage related to dialytrauma.47,48 Cool dialysate has also been found beneficial in the AKI-D setting43 and is therefore a reasonable tool for patients at increased risk of intradialytic hemodynamic instability (Supplement 3 reviews measures to prevent intradialytic hypotension and their benefits and potential pitfalls). Anemia Anemia is a common complication among patients with AKI-D, and nephrologists should address reversible causes of anemia, including iron deficiency. Although intravenous (IV) iron is associated with direct kidney injury and endothelial cell dysfunction in human and animal models,49 there is no definitive evidence that IV iron impairs recovery of kidney function in patients with AKI-D. Therefore, IV iron should be administered to correct iron deficiency when present, but caution should be taken to avoid IV iron protocols targeting supratherapeutic iron stores that are prevalent in the maintenance dialysis population.50 Relatedly, erythropoietin production is decreased during AKI and may lag behind recovery of kidney function.51 Erythropoiesis-stimulating agent (ESA) treatment is currently widely used in the AKI setting.52,53 ESAs are assumed to have similar benefit and risk profile in patients with AKI-D as in those with ESKD, but there are no high-quality data assessing their safety or efficacy in this population, nor are there studies to establish optimal hemoglobin targets. It is reasonable to use ESAs in patients with AKI-D with severe anemia, particularly those with >30 days of dialysis dependence and/or with low recovery phenotype and no contraindications to ESA use. We suggest not targeting a hemoglobin >11 g/dl on the basis of data from the ESKD literature. The primary goal of ESA titration should be prevention of transfusion because allosensitization from blood transfusions may hinder patients' candidacy for kidney transplantation. Bone and Mineral Disease Hyperphosphatemia, hypocalcemia, vitamin D deficiency, and elevated parathyroid hormone are commonly observed in patients with AKI.54,55 The short- and long-term effects of dysregulated mineral metabolism in AKI-D on clinically relevant outcomes, such as kidney function recovery, cardiovascular events, and mortality, are unknown. In this context, no data exist to guide the measurement and management of bone and mineral disease in patients with AKI-D. Patients recovering from critical illness often have vitamin D deficiency, and this should be assessed and treated if present.56 Presumably, patients with low likelihood of kidney function recovery are most susceptible to long-term complications of dysregulated mineral metabolism. Therefore, it is reasonable to apply ESKD bone disease protocols to patients with AKI-D with a low recovery phenotype. In patients with moderate-to-high likelihood of kidney function recovery, we suggest that phosphate binders should be reserved for severe and persistent hyperphosphatemia (>8 mg/dl). The risks from mild–moderate hyperphosphatemia (5–8 mg/dl) are primarily related to long-term exposure beyond the typical observation period for AKI-D recovery. Conversely, hypophosphatemia can have adverse effects, such as muscle weakness, which is more likely to occur in patients with AKI-D. Medication Management Patients with AKI-D typically have a significant medication burden, including many potentially new medications from hospitalization, and are at risk of medication-related complications. In the care of patients with AKI, pharmacist-assisted medication management improves patient knowledge, reduces the risk of nephrotoxin exposure, and lowers rehospitalization rates.57,58 Medication review and management (beyond simple medication reconciliation) at every transition of care is critical to avoid medication-related errors (omissions, duplications, dosing errors, and drug interactions) and to identify nephrotoxins. Nephrotoxins should be avoided whenever possible in the maintenance and recovery phases of AKI. Potential nephrotoxins include NSAIDs, certain antimicrobial agents, proton pump inhibitors, iodinated contrast, and herbal supplements. In patients with moderate-to-high likelihood of recovery of kidney function, alternative medications should be used when clinically feasible. In patients with AKI-D, timed urine collections for creatinine and urea clearances can inform drug dosing.37,59 In anuric patients, an eGFR <10 ml/min should be generally used for drug dosing, but for medications cleared by dialysis, supplemental dosing may be required after dialysis. One should also be aware of cardio and renal protective medications and restart or initiate them in a timely manner as AKI survivors are at high risk of adverse cardiovascular events.60 In large observational studies, use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers is associated with lower post-AKI mortality, although these studies included few patients with AKI-D. Clinicians should consider initiation or restarting of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers early (within 3 months after AKI), with careful monitoring for recurrent AKI and/or hyperkalemia. Similarly, reinitiating or starting sodium glucose cotransporter 2 inhibitors after non–AKI-D is associated with reduced risk of death, progression to kidney disease, and recurrent AKI.64,65 However, no data exist regarding use of sodium glucose cotransporter 2 inhibitors in AKI-D. With regard to statins, these agents should be considered for patients with AKI-D (if no contraindications) because large observational studies have shown that statins are associated with reduced mortality after AKI.66–68 Dialysis Discontinuation There are no uniform criteria for dialysis discontinuation when recovery from AKI-D is suspected. Randomized clinical trials of AKI-D management in the hospital setting have used varying definitions of recovery, requiring UOP of >0.4–0.5/L per day69–71 or creatinine clearance of ≥12 ml/min from a timed urine collection.32 Literature from the ESKD population on incremental dialysis (starting hemodialysis at a frequency of 2×/wk rather than 3×/wk) suggests that hemodialysis frequency of 2×/wk is likely safe in patients with residual urea clearance of >2.0 ml/min.72,73 By analogy, many patients with CKD stage 5 with residual eGFR 5–10 ml/min per 1.73 m2 can be safely maintained off dialysis, albeit with close follow-up. Ultimat