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Kidney Week

Abstract: PO0817

Kidney Function Recovery in Patients Undergoing Maintenance Hemodialysis After AKI Related to Immunological Disorders

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Carvalho, Renata, Hospital de Braga, Braga, Braga, Portugal
  • Faria, B., Hospital de Braga, Braga, Braga, Portugal
Background

Acute kidney injury(AKI) associated with immunological disorders is an important cause of kidney disease leading to dialysis initiation. In most cases, immunosuppression(IS) is maintained after starting dialysis, hoping for dialysis discontinuation. We analyzed our population with AKI due to immune-mediated disease, who were still dialysis-dependent after hospital discharge and were followed at our outpatient hemodialysis(HD) unit.

Methods

We retrieved the data from our HD unit files. Patients that started maintenance HD due to AKI related to immunologic disorders from 2014 to 2021 were included. We collected data on gender, age, AKI etiology, type and dose of IS, time until kidney function recovery, serum creatinine(sC) at admission and discharge, and the result of kidney biopsy if available. Primary outcome was kidney function recovery (with dialysis independence).

Results

16 patients were included. The most common diagnosis was ANCA vasculitis(n=4), followed by ANCA-negative crescentic glomerulonephritis (GN)(n=3), IgA nephropathy(n=2), scleroderma renal crisis(n=2), acute interstitial nephritis(n=2), immune complex GN(n=1), granulomatous interstitial nephritis(n=1) and hemolytic uremic syndrome(n=1). Five patients(31,2%) recovered and are still dialysis-free. Concerning primary outcome, there were no differences in gender or age (58,6±15,1years) between the two groups, but sC at admission was greater in recovered patients (mean 10,7±2,3mg/dL vs 8,2±2,0mg/dL, p=0.047). No differences were found between the two groups when the following variables were analyzed: presence of previous chronic kidney disease (CKD), hypertension, diabetes, acute tubular necrosis or interstitial fibrosis/tubular atrophy in kidney biopsy. In patients who received cyclophosphamide(n=8), the outcome was observed only in one patient after eight cycles of IS(vs3,8±1,3 cycles,p=0.034). The time until recovery was 344±446days(range 66-1121days) and sC after discontinuation of HD was 4,0±0,9mg/dL.

Conclusion

Although rare, patients with immunologic kidney disease can recover kidney function more than 90 days after the start of maintenance HD. As nephrologists we should be aware of this situation. The small number of patients limits our analysis. Nevertheless, we concluded that higher pC at admission is not a risk factor for the outcome and that recovery can occur years after starting HD.