Chronic Dialysis Discontinuation: A Systematic Narrative Review of the Literature in the New Millennium

Abstract

Introduction and aims Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is an uncommon occurrence. At a time when the “too early” start of dialysis is in discussion, a systematic review of the literature for cases in which patients recovered renal function after starting dialysis with chronic indications, including single cases and large series, may lead to attention being focused on this interesting issue. Methods The search strategy was built in Medline on Pubmed, in EMBASE and in the Cochrane Collaboration (August 2013) combining Mesh, Emtree and free terms: dialysis or hemodialysis, kidney function, renal function and recovery (publication date 2000-2013). The following tasks were performed in duplicate: titles and abstracts were manually screened, the data were extracted: title, author, objective, year, journal, period of study, multi-center, country, type of study. Results The systematic review retrieved 1 894 titles; 58 full papers were retrieved and the final selection included 24 papers: 11 case series or Registry data (4 from ANZdata) and 13 case reports. In spite of the high heterogeneity of the studies, overall they suggest that RFR occurs in about 1% of patients, without differences between PD and HD. RFR appears to be more frequent in elderly patients with renal vascular disease (up to 10% RFR in cholesterol emboli or scleroderma), but is reported in all types of primary and secondary kidney diseases. Conclusions RFR is a clinical event that should be looked for, particularly in elderly patients with vascular comorbidity.

Recovery of kidney function in patients treated with maintenance dialysis—a report from the ERA-EDTA Registry

“…In addition, older patients might be more likely to experience pre-ESKD AKI, due to a higher prevalence of heart failure or cardio-renal syndrome in these older patients. Age and sex have been associated with RKF in observational studies employing different definitions of ESKD and RKF (9,10). However, in the ANZDATA Registry, after adjustment for comorbidities, smoking and body mass index, there was no statistically significant independent association of RKF with age, sex, or type of comorbidity (6).…”

“…Data on the incidence of RKF in patients treated with maintenance dialysis in Europe are limited to small case series (1,2), single-center (3,4) and single-country studies (5). Reports from observational studies and registries in other parts of the world show that RKF occurs in 1.0 to 6.7% of dialysis patients (6)(7)(8)(9)(10). However, these studies express large heterogeneity regarding the definitions used for ESKD and RKF, respectively.…”

Factors influencing dialysis withdrawal: a scoping review

“…The grey literature was not included in the search strategy because the authors believe most of the literature related to the objectives of this scoping review are published in the peer-reviewed journals thus contained in the databases. Similar strategy of excluding the grey literature is also used in other reviews on the topic of dialysis and ESRD [ 24 – 27 ]. The systematic search strategy is shown in Appendix (Additional files 1 , 2 and 3 ).…”

Incremental and Personalized Hemodialysis Start: A New Standard of Care

“…This might also favor dialysis discontinuation beyond the 3-6 months conventionally considered as the limit of ESKD reversibility. 24,25 The inclusion also of low-dose, "palliative dialysis" in patients at high comorbidity, as well as situations in which dialysis delivery is limited for economic or logistic reasons, further makes comparisons with standard schedules difficult. 26 Within these different practices, a growing body of case series, reviews, registry data, and expert opinions suggests that incremental HD start, outside the context of economic J o u r n a l P r e -p r o o f restrictions, is at least equivalent to standard hemodialysis start in terms of mortality and morbidity.…”

“…This might also favor dialysis discontinuation beyond the 3 to 6 months conventionally considered as the limit of end-stage kidney disease reversibility. 24 , 25 …”