Do you stop hemodialysis and monitor the patient in clinic, or taper dialysis frequency first, when urine output and lab markers suggest kidney recovery in a hemodynamically stable outpatient with dialysis-requiring AKI?

The absence of interdialytic weight gain is generally the first sign of recovery from acute kidney injury (AKI). However, one thing to avoid getting burned on is the patient with severe heart failure who was previously on high-dose diuretics that were stopped when dialysis began. They may have significant interdialytic weight gain even with recovery of renal function unless diuretics are restarted.

My tendency would be to stop dialysis altogether and monitor the patient in the clinic. Although, this is often a case-by-case decision.

In this circumstance, I tend to taper the frequency of dialysis over a week or two while monitoring volume status and clearance before stopping dialysis. Logistically, it is easier for me to keep a closer eye on the patient this way rather than scheduling labs and clinic visits into an already overbooked clinic. It also reduces the chance that the patient's chair might be given away in the event that the patient doesn't tolerate discontinuation of dialysis.