Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data

Abstract

Background Little is known about factors associated with recovery of kidney function—and return to dialysis independence—or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US. Methods and findings We determined factors associated with recovery of kidney function—defined as survival and discontinuation of dialysis for ≥90-day period—in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43–131) in adults and 100 days (IQR 56–189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74–0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%–40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data. Conclusions In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.

Comparison between peritoneal dialysis and hemodialysis on kidney function recovery in incident kidney failure: A nationwide cohort study

“…In 2021, Elaine et al showed that peritoneal dialysis is associated with less kidney function recovery both in the adult and children population, from USRDS database. This study also showed that patients aged 18–30, patients received dialysis owing to ATN or AIN, and those with no or low comorbidities are associated higher chances of recovery 5 . The controversial association between modalities and kidney recovery remains despite these large‐scale studies.…”

“…This study also showed that patients aged 18-30, patients received dialysis owing to ATN or AIN, and those with no or low comorbidities are associated higher chances of recovery. 5 The controversial association between modalities and kidney recovery remains despite these largescale studies.…”

“…Although the progression from chronic kidney disease (CKD) to kidney failure is usually inevitable, a small proportion of patients entering kidney failure have a chance to regain KRT‐independent kidney function. Previous studies reported a chance of kidney function recovery ranged from 1% to 5% based on different patient populations or definition of “recovery.” 1–5 We considered that “recovery” may occurs in patients suffered an “acute” event superimposed on baseline chronic status, that is, acute kidney injury on CKD. These patients may experience a delayed recovery and need to receive KRT for a certain period, and if recovery occurs, they could wean from KRT.…”

“…Previous studies reported a chance of kidney function recovery ranged from 1% to 5% based on different patient populations or definition of "recovery." [1][2][3][4][5] We considered that "recovery" may occurs in patients suffered an "acute" event superimposed on baseline chronic status, that is, acute kidney injury on CKD. These patients may experience a delayed recovery and need to receive KRT for a certain period, and if recovery occurs, they could wean from KRT.The predictors of kidney function recovery varied with studies but were typically associated with age, numbers of comorbidities, cause of kidney failure, baseline GFR, and duration of nephrologists' follow up.…”

Sustained Recovery of Kidney Function in Patients with ESKD under Chronic Dialysis Treatment: Systematic Review and Meta-Analysis

“…The sustained recovery of kidney function (RKF) is defined as the persistent discontinuation of kidney replacement treatment (KRT) in patients affected by end-stage kidney disease (ESKD) under maintenance dialysis [ 1 ]. Recent large surveys have reported that the prevalence of RKF is surprisingly high (4.5%) [ 2 , 3 ]. This finding is unexpected because (I) ESKD is an irreversible and permanent loss of renal function and (II) chronic dialysis worsens ischemic renal injury, therefore, hampering RKF [ 2 ].…”