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Recovery of Kidney Function in Children Treated with Maintenance Dialysis.

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Authors
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
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Issue Date
2018-10-08

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Citation
Recovery of Kidney Function in Children Treated with Maintenance Dialysis. 2018, 13(10):1510-1516 Clin J Am Soc Nephrol
Abstract
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. 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. 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. 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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Additional Links
https://cjasn.asnjournals.org/content/13/10/1510
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218837/
ae974a485f413a2113503eed53cd6c53
10.2215/CJN.01500218
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