Table 3.

Recommendations for policy changes to improve the care of patients with AKI requiring outpatient dialysis

Policy Change	Description
Recognize AKI requiring dialysis as a distinct clinical entity and different from ESRD	Clinically and administratively distinguish patients with AKI requiring dialysis from patients with ESRD, with the implicit expectation for recovery of renal function
	Nephrologists must not feel pressured by hospital administrators or dialysis units to declare a patient as having ESRD
	Dialysis providers and patients need to be educated on signs of renal function recovery and approaches to limiting additional renal insults
Develop specific protocols for patients with AKI requiring dialysis	Clinical protocols that promote and monitor for renal function recovery should be used in patients with AKI
	Standard ESRD protocols should not be routinely implemented in patients with AKI
Develop a separate reimbursement system for patients with AKI requiring dialysis	Establish a distinct payment system for outpatient AKI dialysis care in ESRD facilities
	Establish reimbursement rates for AKI dialysis care that reflect a higher cost of care than for patients with ESRD because of increased monitoring needs (both physician assessments and laboratory testing)
	Formal recognition as a separately billed entity will encourage centers to develop AKI-specific protocols and procedures
	Coverage of outpatient dialysis by Medicare will permit characterization of this high–risk AKI population through significantly greater data capture
Prioritize research to improve recovery of renal function	Support research on therapeutics to promote recovery of renal function after AKI
	Support research to develop prediction tools or novel biomarkers for recovery of renal function after AKI requiring dialysis
	Support research aimed at establishing best practices for the promotion of recovery of renal function in patients with AKI requiring dialysis