MON-059 RECOVERY OF RENAL FUNCTION IN DIALYSIS AT OUTSOURCING CENTERS

Abstract

Outsourcing of chronic hemodialysis services is a new practice in the gulf region. Renal function recovery (RFR) from chronic dialysis status occurs at a low frequency, however there is no data in outsourcing centers. The aim of this study was to review all cases of recovery of renal function in all the outsourced clinics and highlight this issue of possible recovery and to give a near accurate estimation to the incidence. It is a retrospective chart review of 4189 patients who initiated chronic hemodialysis from September 2013 to September 2018 ( 5 years-study). Eighteen patients (0.4%) recovered their renal function correspond to the incidence of 2.475 per 1000 patient-years. 83% of the RFR events occurred in the first 6 months of dialysis initiation. The group consisted of 7 (39%) males and 11 (61%) females. Patients were 63.6 ± 11.1 years old. The primary disease was diabetic nephropathy in 11 out of the 18 cases, vascular nephropathy in 3/18 cases, glomerulonephritis in 2/18 cases and unknown nephropathy in 2/18 cases. Dialysis was initiated due to uremic symptoms in 8 patients, fluid overload in 5 patients, metabolic acidosis in 3 patients, and hyperkalemia in 2 patients. Median dialysis duration was 2 (1 to 19) months. The mean urine output at dialysis initiation was 1.6 ± 0.5 l/day. Their mean initiation creatinine and BUN levels were 304.4 ±113 μmol/l and 16.6 ± 9 mmol/l, respectively. The mean creatinine and BUN levels at dialysis cessation were 186.7 ± 74 μmol/l and 15.6 ± 11 mmol/l, respectively, while the mean creatinine clearance calculated by 24-hour urine collection was 39.6 ± 24 ml/min. Upon discontinuation, they remained dialysis free for 6.2 ± 5 months. It is important to be aware of the possibility of RFR in some chronic dialysis patients in outsourcing dialysis centers, because continuity of care by referring nephrologist has been interrupted and the diagnosis of end-stage kidney disease was not finalized.