Indicators for Recovery of Renal Function

Although guidelines for initiation of dialysis in End Stage Renal Disease (ESRD) patients are established, little is known about indicators of recovery of renal function. Renal function of dialysis-dependent (DD) patients is seldom followed and when renal function begins to normalize, it may be attributed to malnutrition. We studied a group of DD patients who recovered renal functions and were taken off dialysis. Eight patients with mean age of 53.8 ± 6.7 years ( ± SEM) were identified. Four were male. Three were Caucasian, 3 African American, 1 Asian and 1 Hispanic. The cause of renal failure was focal segmental glomerulonephritis (FSGS) in 4 patients, atheroembolism or contrast nephropathy in 2 patients, membranous glomerulonephritis in 1 patient and vHIV nephropathy in 1 patient. Six patients had uremic symptoms, 1 had rapidly declining renal function and 1 had refractory anasarca. The mean duration on dialysis was 11.1 ± 4.2 months. Four patients had either acute renal failure or acute on chronic renal failure. All had good urine output and 3 had no symptoms on dialysis. The other 5 could not tolerate dialysis due to symptoms. Three patients had normal serum chemistries. Their pre-initiation creatinine was 5.21 ± 0.6 mg/dl and BUN of 72.12 ± 11.12 mg/dl. These patients remained without dialysis for 19.75 ± 5.97 months. The mean creatinine after cessation of dialysis was 2.85 ± 0.57 mg/dl and BUN was 29.62 ± 5.26 mg/dl, while the mean creatinine clearance calculated by 24-hour urine collection was 29.75 ± 4.78 ml/min. One patient who was transferred to other facility died due to HIV complications. All patients except 1 who had to reinitiate dialysis after nine months continue to enjoy a dialysis free life. We therefore suggest that ESRD care providers should be aware of the possibility of recovery of renal function, especially in those who have significant urine output and those with acute renal failure. Dialysis intolerance should be considered a potential indicator of recovery of renal function.