Abstract: SA-OR035

Renal Function Recovery in Incident US Dialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Fwu, Chyng-Wen, Social & Scientific Systems, Inc., Silver Spring, Maryland, United States
  • Abbott, Kevin C., The National Institutes of Health, NIDDK, Bethesda, Maryland, United States
  • Eggers, Paul, Retired, Olney, Maryland, United States
Background

Recovery of renal function (RRF) in ESRD patients is thought to be uncommon, but there are few recent descriptive data. Factors associated with RRF as well as outcomes after RRF are unknown.

Methods

Using USRDS data, we included incident dialysis patients between 2006 and 2015, followed until 6/30/2016. RRF was physician-determined and reported by dialysis facility. Logistic regression examined associations of RRF 6m after dialysis initiation with demographic characteristics and diagnoses causing ESRD. Percent of RRF patients who died, returned to ESRD, and alive and not on ESRD therapy 3y after RRF were determined.

Results

1,087,954 incident dialysis patients from 2006 through 2015 were included. 68,711 patients (6%) recovered renal function during the study. The incidence of RRF within 6m, accounting for 77% of all RRF, was 9.0 cases/1,000 person-months (95% CI, 8.9-9.1). Mean patient age with RRF was 62±15 y compared with 63±15 y for those without RRF (p<0.001). Males, non-Hispanic Whites, younger patients, those receiving hemodialysis as first modality, patients with higher eGFR, and patients with central catheters had greater likelihood of RRF, compared with their counterparts (all p<0.001). Acute interstitial nephritis (AIN; percent with RRF, odds ratio and 95% CI: 40%, 12.8, 11.7-14.0), acute tubular necrosis (ATN; 35%, 8.8, 8.6-9.1), nephrotoxins (18%, 5.1, 4.7-5.5), traumatic or surgical loss of kidney (19%, 4.8, 4.1-5.6), and multiple myeloma (16%, 3.5, 3.3-3.7) had higher odds of RRF, while patients with cystic kidney (1%, 0.4, 0.3-0.4) had lower odds of RRF, compared with patients with diabetes (4%) as primary cause of ESRD. AIN and ATN patients together account for 3% of incident patients, but comprised 18% of all recoveries. At 3y, 53% of recovered patients were still alive and not on ESRD therapy, 32% had died, and 15% were living on ESRD therapy.

Conclusion

RRF is not uncommon, occurs later than previously reported, and is associated with acute kidney injury diagnoses. A majority of patients survive after RRF, but more than 45% of patients with RRF return to ESRD and/or die within the following 3y. To better detect RRF earlier, for the benefit of patients, practitioners and dialysis providers, patients with acute diagnoses and abrupt presentations should receive more intensive monitoring after initiation of dialysis than is currently practiced.

Funding

  • NIDDK Support