Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data

Background Little is known about factors associated with recovery of kidney function—and return to dialysis independence—or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US. Methods and findings We determined factors associated with recovery of kidney function—defined as survival and discontinuation of dialysis for ≥90-day period—in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43–131) in adults and 100 days (IQR 56–189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74–0.89, p-value
In a retrospective study, Elaine Ku and colleagues investigate factors associated with recovery of kidney function among adults and children receiving dialysis reported in the United States Renal Data System.
Author summary Why was this study done? Factors that predict a high potential for recovery of kidney function in dialysis patients are important to identify so that individuals who have the potential for recovery can be closely followed and their recovery recognized. The aim of this study was to determine the likelihood of recovery of kidney function following the start of maintenance dialysis in children and adults. What did the researchers do and find? We found that 4% of children and adults recovered kidney function after starting dialysis, but children were not more likely to recover kidney function compared with adults. Recovery rates improved initially over time in both children and adults but began to decline around 2010 and varied depending on age, race, and cause of kidney disease. What do these findings mean? Discontinuation of outpatient dialysis due to recovery of kidney function was observed in approximately 4% patients with end-stage kidney disease (ESKD) but was especially common among those with acute tubular necrosis (ATN) or acute interstitial nephritis (AIN) as the cause of their kidney disease. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.