Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is an uncommon occurrence. At a time when the “too early” start of dialysis is in discussion, a systematic review of the literature for cases in which patients recovered renal function after starting dialysis with chronic indications, including single cases and large series, may lead to attention being focused on this interesting issue.
Methods
The search strategy was built in Medline on Pubmed, in EMBASE and in the Cochrane Collaboration (August 2013) combining Mesh, Emtree and free terms: dialysis or hemodialysis, kidney function, renal function and recovery (publication date 2000-2013). The following tasks were performed in duplicate: titles and abstracts were manually screened, the data were extracted: title, author, objective, year, journal, period of study, multi-center, country, type of study.
Results
The systematic review retrieved 1 894 titles; 58 full papers were retrieved and the final selection included 24 papers: 11 case series or Registry data (4 from ANZdata) and 13 case reports. In spite of the high heterogeneity of the studies, overall they suggest that RFR occurs in about 1% of patients, without differences between PD and HD. RFR appears to be more frequent in elderly patients with renal vascular disease (up to 10% RFR in cholesterol emboli or scleroderma), but is reported in all types of primary and secondary kidney diseases.
Conclusions
RFR is a clinical event that should be looked for, particularly in elderly patients with vascular comorbidity.
O'HareA.M., RodriguezR.A., HailpernS.M., LarsonE.B., Kurella TamuraM.. Regional variation in health care intensity and treatment practices for end-stage renal disease in older adults.JAMA.2010; 304(2): 180–6.
2.
ShawC., WebbL., CasulaA., TomsonC.R.. Chapter 4 Comorbidities and current smoking status amongst patients starting renal replacement therapy in England, Wales and Northern Ireland from 2009 to 2010.Nephron Clin Pract.2012; 120(suppl 1): c81–c91.
3.
FooteC., NinomiyaT., GallagherM.. Survival of elderly dialysis patients is predicted by both patient and practice characteristics.Nephrol Dial Transplant.2012; 27(9): 3581–3587.
4.
MacedoE., MehtaR.L.. Timing of dialysis initiation in acute kidney injury and acute-on-chronic renal failure.Semin Dial.2013; 26(6): 675–681.
5.
LeungK.C., TonelliM., JamesM.T.. Chronic kidney disease following acute kidney injury-risk and outcomes.Nat Rev Nephrol.2013; 9(2): 77–85.
6.
ChawlaL.S., KimmelP.L.. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome.Kidney Int.2012; 82(5): 516–524.
7.
Sánchez-TomeroJ.A.. Thoughts on the start and withdrawal of dialysis.Nefrologia.2013; 33(6): 758–753.
8.
TreitK., LamD., O'HareA.M.. Timing of dialysis initiation in the geriatric population: toward a patient-centered approach.Semin Dial.2013; 26(6): 682–689.
9.
CooperB.A., BranleyP, BulfoneL.; IDEAL Study. A randomized, controlled trial of early versus late initiation of dialysis.N Engl J Med.2010; 363(7): 609–19.
10.
PanY., XuX.D., GuoL.L., CaiL.L., JinH.M.. Association of early versus late initiation of dialysis with mortality: systematic review and meta-analysis.Nephron Clin Pract.2012; 120(3): c121–c131.
11.
SusantitaphongP, AltamimiS., AshkarM.. GFR at initiation of dialysis and mortality in CKD: a meta-analysis.Am J Kidney Dis.2012; 59(6): 829–840.
12.
LameireN., VanbiesenW., VanholderR.. When to start dialysis in patients with acute kidney injury? When semantics and logic become entangled with expectations and beliefs.Crit Care.2011; 15(4): 171.
13.
Fernández-LucasM., Teruel-BrionesJ.L., Gomis-CoutoA., Villacorta-PérezJ., Quereda-Rodríguez-NavarroC.. Maintaining residual renal function in patients on haemodialysis: 5-year experience using a progressively increasing dialysis regimen.Nefrologia.2012; 32(6): 767–776.
14.
BellomoR., RoncoC., KellumJ.A., MehtaR.L., PalevskyP.. Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.Crit Care.2004; 8(4): R204–R212.
15.
ChuJ.K., FolkertV.W.. Renal function recovery in chronic dialysis patients.Semin Dial.2010; 23(6): 606–613.
16.
CasinoF.G., LopezT.. The equivalent renal urea clearance: a new parameter to assess dialysis dose.Nephrol Dial Transplant.1996; 11(8): 1574–1581.
17.
PiccoliG.B., FerraresiM., DeagostiniM.C.. Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many?Nephrol Dial Transplant.2013; 28(9): 2295–2305.
18.
TangW., McDonaldSP, HawleyC.M.. End-stage renal failure due to amyloidosis: outcomes in 490 ANZDATA registry cases.Nephrol Dial Transplant.2013; 28(2): 455–461.
19.
Fernández-LucasM., Teruel-BrionesJ.L., GomisA.. Recovery of renal function in patients receiving haemodialysis treatment.Nefrologia.2012; 32(2): 166–171.
20.
SivaB., McDonaldS.P., HawleyC.M.. End-stage kidney disease due to scleroderma—outcomes in 127 consecutive ANZDATA registry cases.Nephrol Dial Transplant.2011; 26(10): 3165–3171.
21.
Fehrman-EkholmI., BergenhagA.C., HeimburgerO., SchönS.. Recovery of renal function after one-year of dialysis treatment: case report and registry data.Int J Nephrol.2010; 2010: 817836.
22.
MacdonaldJ.A., McDonaldS.P., HawleyC.M.. Recovery of renal function in end-stage renal failure—comparison between peritoneal dialysis and haemodialysis.Nephrol Dial Transplant.2009; 24(9): 2825–2831.
23.
SiddiquiS., NorburyM., RobertsonS., AlmondA., IslesC.. Recovery of renal function after 90 d on dialysis: implications for transplantation in patients with potentially reversible causes of renal failure.Clin Transplant.2008; 22(2): 136–140.
24.
CravenA.M., HawleyC.M., McDonaldS.P., RosmanJ.B., BrownF.G., JohnsonD.W.. Predictors of renal recovery in Australian and New Zealand end-stage renal failure patients treated with peritoneal dialysis.Perit Dial Int.2007; 27(2): 184–191.
25.
AgraharkarM., NairV., PatlovanyM.. Recovery of renal function in dialysis patients.BMC Nephrol.2003; 4: 9.
26.
ThériaultJ., AgharazziM., DumontM., PichetteV., OuimetD., LeblancM.. Atheroembolic renal failure requiring dialysis: potential for renal recovery? A review of 43 cases.Nephron Clin Pract.2003; 94(1): c11–c18.
27.
GoldsteinA., KligerA.S., FinkelsteinF.O.. Recovery of renal function and the discontinuation of dialysis in patients treated with continuous peritoneal dialysis.Perit Dial Int.2003; 23(2): 151–156.
28.
KatzI.J., SofianouL., ButlerO., HopleyM.. Recovery of renal function in Black South African patients with malignant hypertension: superiority of continuous ambulatory peritoneal dialysis over hemodialysis.Perit Dial Int.2001; 21(6): 581–586.
29.
MalinaM., SchaeferB., WaldherrR., WühlE., SchaeferF., SchmittC.P.. Late recovery of renal function by rituximab in a patient with Wegener's granulomatosis.Pediatr Nephrol.2013; 28(3): 511–514.
30.
RossS., BenzK., SauersteinK., AmannK., DötschJ., DittrichK.. Unexpected recovery from longterm renal failure in severe diffuse proliferative lupus nephritis.BMC Nephrol.2012; 13: 81.
31.
MiwaM., SakaoY., IshigakiS.. Recovery of kidney function by rituximab-based therapy in a patient with Waldenström's macroglobulinemia-related nephropathy presenting cast nephropathy and interstitial lymphocytic infiltration.Intern Med.2012; 51(13): 1725–1730.
32.
de Alarcón JiménezR.M., Roca MeroñoS., Alvarez FernándezG.M.. Recuperación parcial de la función renal tras trasplante autólogo en paciente con enfermedad renal crónica y mieloma múltiple. (in Spanish) [Partial recovery of kidney function for an autologous transplant in a patient with chronic kidney disease and multiple myeloma].Nefrologia.2011; 31(2): 238–240.
33.
Georgaki-AngelakiH., StergiouN., KapogiannisA., OrfanouI., GrapsaB., RomaE.. Atypical hemolytic-uremic syndrome (HUS) with recovery after a long-lasting anuria: a case report.Hippokratia.2011; 15(1): 90–92.
34.
HidalgoP., JiménezT., BlancaL.. Recovery of native renal function after kidney transplantation.Transplant Proc.2010; 42(8): 3137–3140.
35.
BigéN., GuéryB., DelarueR., NoëlL.H., FakhouriF.. Late recovery of renal failure after autologous haematopoietic stem cell transplantation for multiple myeloma: a report of two cases.NDT Plus2009; 2: 242–245.
36.
TaftiB.A., HaghdoostM., AlvarezL., CuretM., MelcherM.L.. Recovery of renal function in a dialysis-dependent patient following gastric bypass surgery.Obes Surg.2009; 19(9): 1335–1339.
37.
OliveiraL., WangD., McCormickB.B.. A case report of plasmapheresis and cyclophosphamide for steroid-resistant focal segmental glomerulosclerosis: recovery of renal function after five months on dialysis.Ther Apher Dial.2007; 11(3): 227–231.
38.
KatoA., OhtsujiA., TeradaT.. Recovery from hemodialysis therapy in a patient with renal cholesterol crystal embolism.Nephron.2002; 92(1): 240–243.
39.
TauroS., ClarkF.J., DuncanN., LipkinG., RichardsN., MahendraP.. Recovery of renal function after autologous stem cell transplantation in myeloma patients with end-stage renal failure.Bone Marrow Transplant.2002; 30(7): 471–473.
40.
MoralesE., MartinezA., Sánchez-AyusoJ.. Spontaneous improvement of the renal function in a patient with HIV-associated focal glomerulosclerosis.Am J Nephrol.2002; 22(4): 369–371.
41.
CohenD.L., TownsendR.R., KobrinS., GenegaE.M., TomaszewskiJ.E., FairmanR.. Dramatic recovery of renal function after 6 months of dialysis dependence following surgical correction of total renal artery occlusion in a solitary functioning kidney.Am J Kidney Dis.2001; 37(1): E7.
42.
WangA.Y., LaiK.N.. The importance of residual renal function in dialysis patients.Kidney Int.2006; 69(10): 1726–1732.
43.
BrenerZ.Z., KotankoP., ThijssenS., WinchesterJ.F., BergmanM.. Clinical benefit of preserving residual renal function in dialysis patients: an update for clinicians.Am J Med Sci.2010; 339(5): 453–456.
44.
ChandnaS.M., FarringtonK.. Residual renal function: considerations on its importance and preservation in dialysis patients.Semin Dial.2004; 17(3): 196–201.
45.
KjellstrandC.M., BuoncristianiU., TingG.. Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years.Nephrol Dial Transplant.2008; 23(10): 3283–3289.
46.
PiccoliG.B., MottaD., GaiM.. Tailored dialysis start may allow persistence of residual renal function after graft failure: a case report.Transplant Proc.2004; 36(9): 2607–2609.
47.
PiccoliG.B., BurdeseM., MezzaE.. Maintenance of residual renal function 10 years after the start of hemodialysis: the advantage of tailored schedules?Int J Artif Organs.2004; 27(3): 251–254.
