There are potentially modifiable predictors of kidney recovery, such as dialysis prescription,which have not been fully examined.
Retrospective cohort study using United States Renal Data System (USRDS) data was used to identify incident hemodialysis (HD) patients between 2012 and 2016, the first 4 years for which dialysis treatment data is available. Patient and treatment characteristics were compared between those that recovered versus those that remained dialysis-dependent. A time-dependent survival model was used to identify independent predictors of kidney recovery.
Results: During the study period, there were 372,387 incident hemodialysis patients with available data, among whom 16,930 (4.5%) recovered to dialysis-independence. Compared to non-recovery, a higher proportion of patients with kidney recovery were of white race, and non-Hispanic ethnicity. Both groups had a similar age distribution. Patients with an acute kidney injury diagnosis as primary cause of End-Stage Renal Disease were most likely to recover, but the most common diagnosis among recovering patients was type 2 diabetes (29.8% of recovery cases). Higher Estimated Glomerular Filtration Rate (eGFR) and lower albumin at End-Stage Renal Disease initiation were associated with increased likelihood of recovery. When examining hemodialysis ultrafiltration rate (UFR), the higher ultrafiltration rate was connected to lower recovery.
Conclusions: There were identified non-modifiable and potentially modifiable factors associated with kidney recovery which may assist clinicians in counseling and monitoring incident End-Stage Renal Disease patients with a greater chance to gain dialysis-independence, but they require clinical approval.