Recovery of Kidney Function in Children Treated with Maintenance Dialysis.

Bonthuis, Marjolein; Harambat, Jérôme; Bérard, Etienne; Cransberg, Karlien; Duzova, Ali; Garneata, Liliana; Herthelius, Maria; Lungu, Adrian C; Jahnukainen, Timo; Kaltenegger, Lukas; Ariceta, Gema; Maurer, Elisabeth; Palsson, Runolfur; Sinha, Manish D; Testa, Sara; Groothoff, Jaap W; Jager, Kitty J (2018). Recovery of Kidney Function in Children Treated with Maintenance Dialysis. Clinical journal of the American Society of Nephrology, 13(10), pp. 1510-1516. American Society of Nephrology 10.2215/CJN.01500218

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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.

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