Abstract
BackgroundESRD is considered an irreversible loss of renal function, yet some patients will recover kidney function sufficiently to come off dialysis. Potentially modifiable predictors of kidney recovery, such as dialysis prescription, have not been fully examined.MethodsRetrospective cohort study using United States Renal Data System (USRDS) data to identify incident hemodialysis (HD) patients between 2012 and 2016, the first 4 years for which dialysis treatment data is available. The primary outcome was kidney recovery within 1 year of ESRD and HD initiation, defined by a specific recovery code and survival off dialysis for at least 30 days. Patient and treatment characteristics were compared between those that recovered versus those that remained dialysis-dependent. A time-dependent survival model was used to identify independent predictors of kidney recovery.ResultsDuring the study period, there were 372,387 incident HD patients with available data, among whom 16,930 (4.5%) recovered to dialysis-independence. Compared to non-recovery, a higher proportion of patients with kidney recovery were of white race, and non-Hispanic ethnicity. Both groups had a similar age distribution. Patients with an acute kidney injury diagnosis as primary cause of ESRD were most likely to recover, but the most common ESRD diagnosis among recovering patients was type 2 diabetes (29.8% of recovery cases). Higher eGFR and lower albumin at ESRD initiation were associated with increased likelihood of recovery. When examining HD ultrafiltration rate (UFR), each quintile above the first quintile was associated with a progressively lower likelihood of recovery (HR 0.45, 95% CI 0.43–0.48 for highest versus lowest quintile, p < 0.001).ConclusionsWe identified non-modifiable and potentially modifiable factors associated with kidney recovery which may assist clinicians in counseling and monitoring incident ESRD patients with a greater chance to gain dialysis-independence. Clinical trials are warranted to examine the impact of dialysis prescription on subsequent kidney function recovery.
Highlights
end-stage renal disease (ESRD) is considered an irreversible loss of renal function, yet some patients will recover kidney function sufficiently to come off dialysis
A proportion of such patients will recover kidney function sufficient to come off dialysis, at least for a period of time – as high as 5–6% of incident ESRD patients in recent years [1, 2]
Over the past two decades there has been a marked overall increase in kidney function recovery among incident ESRD patients. In this national analysis of United States Renal Data System (USRDS) data that included a first examination of CROWNWeb data in this context, we identified clinical characteristics and potentially modifiable treatment factors associated with recovery to dialysis independence, a highly relevant, patient-centered outcome
Summary
ESRD is considered an irreversible loss of renal function, yet some patients will recover kidney function sufficiently to come off dialysis. A proportion of such patients will recover kidney function sufficient to come off dialysis, at least for a period of time – as high as 5–6% of incident ESRD patients in recent years [1, 2]. Identification of patient factors associated with recovery can help guide both patient and provider expectations and assist in monitoring for recovery. This can be important because kidney function recovery in the dialysis center may not be recognized if not actively searched for. Under-recognition of recovery can result in patients remaining on dialysis longer than necessary
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