Abstract: FR-PO1015
When End-Stage Isn't Final: Late Renal Recovery After Prolonged Dialysis Dependence
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Gangadharan, Keerthana, UPMC, Pittsburgh, Pennsylvania, United States
- Lakhatariya, Khushboo, UPMC, Pittsburgh, Pennsylvania, United States
- Pulusu, Vinay Krishna, UPMC, Pittsburgh, Pennsylvania, United States
- Simoneau, Emily, UPMC, Pittsburgh, Pennsylvania, United States
- Thakkar, Jyotsana, UPMC, Pittsburgh, Pennsylvania, United States
Introduction
Recovery of kidney function after prolonged dialysis is rare but increasingly recognized. We report late recovery after 2 years of presumed irreversible end-stage kidney disease (ESKD).
Case Description
A 66-year-old man underwent bilateral lung transplantation complicated by hypoxic respiratory failure requiring Extracorporeal Membrane Oxygenation. Baseline kidney function was normal (creatinine 0.7–0.9 mg/dL). He developed oliguric acute kidney injury (AKI) due to acute tubular necrosis, creatinine peaked at 2.9 mg/dL with refractory volume overload requiring continuous renal replacement therapy followed by intermittent hemodialysis (HD). He remained oliguric and dialysis-dependent for 2 years, attributed to AKI and calcineurin inhibitor (CNI) nephrotoxicity. Immunosuppression was then transitioned to belatacept. During a subsequent hospitalization for pneumonia, urine output was noted to have increased (up to 2 L/day without diuretics). A 24-hour urine collection showed creatinine clearance of 34 mL/min, and HD was discontinued. He has remained dialysis-independent for 1 year with CKD stage 4.
Discussion
Recovery after prolonged dialysis is uncommon but possible. Some studies suggest that approximately 1–2% may recover sufficient renal function to discontinue dialysis. Recovery is more likely in patients with AKI-related primary diagnoses. Preservation of residual renal function and avoidance of recurrent nephrotoxic injury may also contribute to gradual recovery over time. Clinical factors predicting recovery include preserved urine output, higher eGFR at dialysis initiation, shorter dialysis duration, fewer chronic fibrotic kidney changes, and AKI superimposed on CKD rather than irreversible progressive nephropathy. In this case, discontinuation of calcineurin inhibitor (CNI) therapy may also have contributed to renal recovery. CNIs are associated with dose-dependent nephrotoxicity through renal vasoconstriction, tubular injury, and chronic interstitial fibrosis. Withdrawal of the offending agent can lead to partial or complete improvement in kidney function, particularly when nephrotoxicity is identified early.
This case highlights the importance of continued monitoring of residual kidney function even in long-term dialysis patients.