Liberation From Acute Dialysis

Inclusion Criteria: * ≥ 18 years of age * Inpatient with AKI-D (intermittent hemodialysis or continuous renal replacement therapy received on at least one calendar day) at least partially due t acute tubular necrosis per the clinical nephrology team * Hemodynamic stability: not requiring vasopressor support and with planned intermittent dialysis * Baseline estimated glomerular filtration rate (eGFR) ≥ 15 mL/min/1.73 m2 Exclusion Criteria: * Nontraditional indication for dialysis (end-stage liver disease awaiting transplantation, fulminant hepatic failure, intoxication) * Complete nephrectomy as cause of AKI-D * Kidney transplant during index hospitalization * Dialysis \> 3 months * Decompensated heart failure requiring left ventricular assist device or continuous inotropic support * Mechanical ventilation via endotracheal tube * Hypoxemia requiring significant oxygen support: \>5 liters/min via nasal cannula or equivalent via face mask/tracheostomy mask to maintain oxygen saturation \> 95%, or requiring fraction of inspired oxygen \>50% in patients with tracheostomy requiring invasive or non-invasive ventilation * Unable to consent and no surrogate decisionmaker available * Pregnant * Prisoner * Clinical team declines to allow study participation * Anticipated discharge or transfer from study hospital within 48 hours