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Renal function recovery in chronic dialysis patients
1Division of Nephrology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA.
Seminars in Dialysis
|December 21, 2010
Summary
Renal function recovery from chronic dialysis is uncommon, occurring in 1.0-2.4% of patients. Etiology of renal failure significantly predicts recovery, with specific diseases like diabetic nephropathy having low rates.
Area of Science:
- Nephrology
- Renal Medicine
- Dialysis Research
Background:
- Renal function recovery (RFR) after acute kidney injury requiring dialysis is frequent.
- RFR from chronic dialysis is uncommon (1.0-2.4%) but recognized.
- Identifying predictors for RFR in chronic dialysis patients is crucial.
Purpose of the Study:
- To review the phenomenon of renal function recovery in patients on chronic dialysis.
- To identify factors influencing RFR in this population.
- To outline the diagnostic and management approach for RFR.
Main Methods:
- Review of large observational studies on RFR in chronic dialysis patients.
- Analysis of underlying etiologies of renal failure as predictors of RFR.
- Discussion of diagnostic methods including 24-hour urine urea and creatinine clearance.
- Evaluation of clinical and laboratory signs suggestive of RFR.
Main Results:
- The underlying cause of renal failure is the primary predictor of RFR.
- Diseases like atheroembolic renal disease, autoimmune diseases, renovascular diseases, and scleroderma show higher RFR rates.
- Diabetic nephropathy and cystic kidney disease have the lowest RFR rates.
- Dialysis modality does not influence RFR outcomes.
Conclusions:
- RFR from chronic dialysis is possible, with etiology being a key determinant.
- Early recognition of nonspecific signs and appropriate diagnostic testing are essential.
- Gradual reduction of dialysis prescription based on measured renal clearance can lead to discontinuation.
- Post-recovery patients require ongoing chronic kidney disease management.
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