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

Lily Jakulj, Anneke Kramer (Lead / Corresponding author), Anders Åsberg, Johan de Meester, Carmen Santiuste de Pablos, Jaakko Helve, Marc H. Hemmelder, Alexandre Hertig, Mustafa Arici, Samira Bell, Lucile Mercadal, Carmen Diaz-Corte, Runolfur Palsson, Manuel Benítez Sánchez, Julia Kerschbaum, Frederic Collart, Ziad A. Massy, Kitty J. Jager, Marlies Noordzij

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Abstract

Background : Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. over 90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients.

Methods: We included adult patients from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox-regression analyses.

Results: RKF occurred in 7,657 (1.8%) of 440,996 patients of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first two years after day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within one year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis (adjusted Hazard Ratio [aHR]: 20.4, 95%CI: 17.9-23.1), systemic sclerosis (aHR: 18.5, 95%CI: 13.8-24.7) and hemolytic uremic syndrome (aHR: 17.3, 95%CI: 13.9-21.6). Weaker associations were found for, hemodialysis as first dialysis-modality (aHR: 1.5, 95%CI: 1.4-1.6) and dialysis initiation at an older age (aHR: 1.8, 95%CI: 1.6-2.0) or in a more recent time-period (aHR: 2.4, 95%CI: 2.1-2.7).

Conclusions: Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.
Original languageEnglish
JournalNephrology Dialysis Transplantation
Early online date23 Dec 2020
DOIs
Publication statusE-pub ahead of print - 23 Dec 2020

Keywords

  • recovery of kidney function
  • maintenance dialysis
  • hemodialysis
  • peritoneal dialysis

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