University of Michigan Medical School, 1500 E. Medical Center Drive, SPC 5364, Ann Arbor, MI, 48109-5364, USA.
University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, USA.
BMC Nephrol. 2021 Apr 21;22(1):142. doi: 10.1186/s12882-021-02345-7.
ESRD is considered an irreversible loss of renal function, yet some patients will recover kidney function sufficiently to come off dialysis. Potentially modifiable predictors of kidney recovery, such as dialysis prescription, have not been fully examined.
Retrospective cohort study using United States Renal Data System (USRDS) data to identify incident hemodialysis (HD) patients between 2012 and 2016, the first 4 years for which dialysis treatment data is available. The primary outcome was kidney recovery within 1 year of ESRD and HD initiation, defined by a specific recovery code and survival off dialysis for at least 30 days. 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.
During the study period, there were 372,387 incident HD 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 ESRD were most likely to recover, but the most common ESRD diagnosis among recovering patients was type 2 diabetes (29.8% of recovery cases). Higher eGFR and lower albumin at ESRD initiation were associated with increased likelihood of recovery. When examining HD ultrafiltration rate (UFR), each quintile above the first quintile was associated with a progressively lower likelihood of recovery (HR 0.45, 95% CI 0.43-0.48 for highest versus lowest quintile, p < 0.001).
We identified non-modifiable and potentially modifiable factors associated with kidney recovery which may assist clinicians in counseling and monitoring incident ESRD patients with a greater chance to gain dialysis-independence. Clinical trials are warranted to examine the impact of dialysis prescription on subsequent kidney function recovery.
终末期肾病（ESRD）被认为是肾功能不可逆丧失，但有些患者的肾功能会恢复到足以脱离透析的程度。尚未充分研究可改变的肾功能恢复预测因素，如透析处方。
使用美国肾脏数据系统（USRDS）数据进行回顾性队列研究，以确定 2012 年至 2016 年期间发生的血液透析（HD）患者，这是可用的透析治疗数据的前 4 年。主要结局是在 ESRD 和 HD 开始后 1 年内恢复肾脏功能，定义为特定的恢复代码和至少 30 天的无透析生存。比较恢复组和持续依赖透析组患者和治疗特征。使用时间依赖性生存模型确定肾脏恢复的独立预测因素。
在研究期间，有 372387 例符合条件的新发 HD 患者，其中 16930 例（4.5%）恢复到透析独立性。与未恢复相比，恢复组中白种人和非西班牙裔的比例更高。两组的年龄分布相似。急性肾损伤作为 ESRD 的主要病因的患者最有可能恢复，但恢复患者中最常见的 ESRD 诊断是 2 型糖尿病（29.8%的恢复病例）。ESRD 起始时更高的 eGFR 和更低的白蛋白与更高的恢复可能性相关。当检查 HD 超滤率（UFR）时，每个高于第一五分位数的五分位数与恢复可能性降低相关（最高五分位数与最低五分位数相比，HR 0.45，95%CI 0.43-0.48，p<0.001）。
我们确定了与肾脏恢复相关的不可改变和潜在可改变的因素，这些因素可能有助于临床医生为有更大机会获得透析独立性的新发 ESRD 患者提供咨询和监测。需要进行临床试验来检查透析处方对随后肾功能恢复的影响。
