ESPN 50th Annual Meeting

ESPN 2017


 
Recovery of renal function in children on chronic dialysis: A report from the ESPN/ERA-EDTA Registry
Marjolein Bonthuis 1 Jérôme Harambat 2 Jaap W. Groothoff 3 Kitty J. Jager 1

1- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
2- Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France
3- Department of Pediatric Nephrology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
 
Introduction:

Data on recovery of renal function after chronic dialysis at paediatric age are scarce.

We examined the incidence of recovery of renal function and its potential determinants in a large cohort of paediatric dialysis patients in Europe.

Material and methods:

Data of 6597 patients commencing dialysis at an age of 15 years or younger between 1990 and 2014 were extracted from the ESPN/ERA-EDTA Registry. Recovery of renal function was defined as discontinuing dialysis for 30 days or more. We used a cumulative incidence competing risk approach and adjusted Cox proportional hazard models to study time to recovery.

Results:

After a median of 4.5 (IQR: 1.7-8.7) months on dialysis 149 (2.3%) patients experienced renal function recovery. Sixty percent of the patients recovered their renal function within six months after commencing dialysis, while 15% recovered beyond 12 months on dialysis.

Recovery occurred in 14.6% of ischaemic renal failure, 15.0% of HUS and 11.1% of vasculitis patients. Hence, these patients had an increased likelihood to recover their renal function as compared to CAKUT patients: vasculitis (aHR: 18.64, 95%CI: 8.95-38.80), HUS (aHR: 17.09, 95% CI: 9.90-29.48), and ischaemic renal failure (aHR: 15.43, 95% CI: 7.95-29.86). Younger age (<12 years) when commencing dialysis was also associated with a higher recovery risk.

For 50 patients (35%) renal function recovery was transient, as they had to restart renal replacement therapy after a median recovery period of 19.7 (IQR: 8.1- 41.3) months.

Conclusions:

We demonstrate a renal  function recovery rate of 2.3% in the largest cohort of children on chronic dialysis studied to date. Cause of renal failure and patient age were the main determinants of renal function recovery. Caution is appropriate when planning renal transplantation too soon after dialysis initiation in patients with HUS, vasculitis and ischaemic renal failure.