Recovery of renal function after 90 d on dialysis: implications for transplantation in patients with potentially reversible causes of renal failure

Background: Late recovery of renal function in patients requiring dialysis is a well recognized but uncommon phenomenon. Moves to increase the number of live donor transplants and the recognition that early transplantation is associated with better graft survival means it is possible that patients who are going to recover renal function may be transplanted unnecessarily. Design: Prospective survey of patients receiving dialysis for more than 90d in south west Scotland from 1 January 1994 to 31 December 2005. Methods: Routine measurement of residual renal function by combined urea and creatinine clearance allowed us to detect late recovery whenever this occurred. Results: Eight of 202 (4%) patients recovered sufficient renal function to stop dialysing after 90-d treatment. The likely cause of the renal failure in five of these patients was atheroembolism. One with atherosclerotic renovascular disease had been stented and would have received a live related renal transplant had his sister not had second thoughts about the procedure. Conclusion: It may be sensible to postpone transplantation in patients with certain types of renal failure, perhaps particularly patients with renovascular disease who have recently undergone a failed revascularization procedure.