Recovery of Kidney Function in Children Treated with Maintenance Dialysis

ESPN/ERA-EDTA Registry

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1510-1516
Number of pages7
JournalClinical journal of the American Society of Nephrology : CJASN
Volume13
Issue number10
DOIs
Publication statusPublished - Oct 8 2018

Keywords

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

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Fingerprint Dive into the research topics of 'Recovery of Kidney Function in Children Treated with Maintenance Dialysis'. Together they form a unique fingerprint.

  • Cite this