How Many ESRD Patients Undergoing Dialysis Regain Kidney Function?

More than 5 percent of Medicare patients starting hemodialysis go on to have sustained recovery of renal function, according to a study in the open-access journal PLOS One.

The researchers analyzed follow-up data on 194,007 patients in the United States who began receiving hemodialysis in 2008 or 2009, with outcomes tracked through 2010. Sustained recovery of renal function was assessed, defined as an event code of “9” and no return for dialysis or transplantation through at least 1 year. The analysis excluded patients with temporary recovery of renal function who subsequently returned to dialysis.

Overall, 6.69 percent of patients had evidence of recovery of renal function, although 14.8 percent of these returned to dialysis during follow-up. The rate of sustained recovery of renal function increased from 5.6 percent in 2008 to 5.9 percent in 2009. Renal recovery mainly occurred in the first 2 months after dialysis initiation and was associated with etiologic factors associated with acute kidney injury, most commonly acute tubular necrosis.

The patients with sustained renal recovery had very low rates of permanent vascular access. Consistent with this, recovery was less likely for patients who had any previous nephrologist contact. These findings suggested that patients with a slower, chronic disease process may have more time for long-term access planning.

Renal recovery was also less likely for nonwhite patients. Recovery rates varied widely by region, from 3.4 percent in ESRD network 3 to 7.6 percent in network 7.

Recent estimates of renal recovery in patients starting long-term hemodialysis have ranged from 0.9 percent to 2.3 percent. This large analysis of patients enrolled in the U.S. Medicare ESRD program finds much higher rates of over 5 percent. The authors suggest that ESRD patients with diagnoses associated with acute kidney injury may benefit from close monitoring of residual kidney function and interventions to avoid further renal injury [Mohan S, et al. Recovery of renal function among ESRD patients in the US Medicare program. PLoS ONE 2013;8:e83447. doi: 10.1371/journal.pone.0083447].