Tags

Type your tag names separated by a space and hit enter

Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data.
PLoS Med. 2021 02; 18(2):e1003546.PM

Abstract

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 <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data.

CONCLUSIONS

In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. 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.

Authors+Show Affiliations

University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America. University of California San Francisco, Division of Pediatric Nephrology, Department of Pediatrics, San Francisco, California, United States of America. University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America.University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America.Hennepin Healthcare and University of Minnesota, Department of Medicine, Division of Nephrology, Minneapolis, Minnesota, United States of America.University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America.Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, Cincinnati, Ohio, United States of America.University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America.University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America. University of California San Francisco, Department of Anesthesia and Perioperative Care, San Francisco, California, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33606673

Citation

Ku, Elaine, et al. "Recovery of Kidney Function After Dialysis Initiation in Children and Adults in the US: a Retrospective Study of United States Renal Data System Data." PLoS Medicine, vol. 18, no. 2, 2021, pp. e1003546.
Ku E, Hsu RK, Johansen KL, et al. Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data. PLoS Med. 2021;18(2):e1003546.
Ku, E., Hsu, R. K., Johansen, K. L., McCulloch, C. E., Mitsnefes, M., Grimes, B. A., & Liu, K. D. (2021). Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data. PLoS Medicine, 18(2), e1003546. https://doi.org/10.1371/journal.pmed.1003546
Ku E, et al. Recovery of Kidney Function After Dialysis Initiation in Children and Adults in the US: a Retrospective Study of United States Renal Data System Data. PLoS Med. 2021;18(2):e1003546. PubMed PMID: 33606673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data. AU - Ku,Elaine, AU - Hsu,Raymond K, AU - Johansen,Kirsten L, AU - McCulloch,Charles E, AU - Mitsnefes,Mark, AU - Grimes,Barbara A, AU - Liu,Kathleen D, Y1 - 2021/02/19/ PY - 2020/01/27/received PY - 2021/01/22/accepted PY - 2021/03/05/revised PY - 2021/2/20/pubmed PY - 2021/2/20/medline PY - 2021/2/19/entrez SP - e1003546 EP - e1003546 JF - PLoS medicine JO - PLoS Med VL - 18 IS - 2 N2 - 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 <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data. CONCLUSIONS: In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. 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. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/33606673/Recovery_of_kidney_function_after_dialysis_initiation_in_children_and_adults_in_the_US:_A_retrospective_study_of_United_States_Renal_Data_System_data_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003546 DB - PRIME DP - Unbound Medicine ER -