Recovery of Kidney Function in Children Treated with Maintenance Dialysis

Abstract

Background and objectives: Data on recovery of kidney function in pediatric patients with presumed ESKD are scarce. We examined the occurrence of recovery of kidney function and its determinants in a large cohort of pediatric patients on maintenance dialysis in Europe.

Design, setting, participants, & measurements: Data for 6574 patients from 36 European countries commencing dialysis at an age below 15 years, between 1990 and 2014 were extracted from the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Recovery of kidney function was defined as discontinuation of dialysis for at least 30 days. Time to recovery was studied using a cumulative incidence competing risk approach and adjusted Cox proportional hazard models.

Results: Two years after dialysis initiation, 130 patients (2%) experienced recovery of their kidney function after a median of 5.0 (interquartile range, 2.0-9.6) months on dialysis. Compared with patients with congenital anomalies of the kidney and urinary tract, recovery more often occurred in patients with vasculitis (11% at 2 years; adjusted hazard ratio [HR], 20.4; 95% confidence interval [95% CI], 9.7 to 42.8), ischemic kidney failure (12%; adjusted HR, 11.4; 95% CI, 5.6 to 23.1), and hemolytic uremic syndrome (13%; adjusted HR, 15.6; 95% CI, 8.9 to 27.3). Younger age and initiation on hemodialysis instead of peritoneal dialysis were also associated with recovery. For 42 patients (32%), recovery was transient as they returned to kidney replacement therapy after a median recovery period of 19.7 (interquartile range, 9.0-41.3) months.

Conclusions: We demonstrate a recovery rate of 2% within 2 years after dialysis initiation in a large cohort of pediatric patients on maintenance dialysis. There is a clinically important chance of recovery in patients on dialysis with vasculitis, ischemic kidney failure, and hemolytic uremic syndrome, which should be considered when planning kidney transplantation in these children.

Keywords: Cohort Studies; ESRD; Edetic Acid; Hemolytic-Uremic Syndrome; Incidence; Kidney Failure, Chronic; Proportional Hazards Models; Registries; Renal Insufficiency; chronic dialysis; kidney; kidney transplantation; pediatric nephrology; peritoneal dialysis; renal dialysis; renal function recovery; vasculitis.

Graphical abstract

Figure 1.

Two-percent of recovery of kidney function after two years on maintenance dialysis, and the competing risks death, lost to follow-up, and kidney transplantation.

Figure 2.

Much higher cumulative incidence of patients experiencing recovery of kidney function in HUS, ischemic kidney failure, and vasculitis, compared with other primary kidney disorders. HUS, hemolytic uremic syndrome.