Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data
Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function...
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| creator | Ku, Elaine Hsu, Raymond K Johansen, Kirsten L McCulloch, Charles E Mitsnefes, Mark Grimes, Barbara A Liu, Kathleen D |
| description | Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US.
We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value |
| doi_str_mv | 10.1371/JOURNAL.PMED.1003546 |
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We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data.
In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/JOURNAL.PMED.1003546</identifier><identifier>PMID: 33606673</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute renal failure ; Adults ; Biology and Life Sciences ; Calendars ; Cardiovascular disease ; Care and treatment ; Children ; Chronic kidney failure ; Comorbidity ; Demographic aspects ; Hemodialysis ; Hispanic people ; Kidney diseases ; Kidneys ; Medicare ; Medicine and Health Sciences ; Patient outcomes ; Patients ; People and Places ; Peritoneal dialysis ; Peritoneum ; Recovery of function ; Transplants & implants ; Trends</subject><ispartof>PLoS medicine, 2021-02, Vol.18 (2), p.e1003546-e1003546</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Ku et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Ku et al 2021 Ku et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-db38729e87afe43d833afa989b583c7037135eb12982b56bbaf6a16bb303c1823</citedby><cites>FETCH-LOGICAL-c764t-db38729e87afe43d833afa989b583c7037135eb12982b56bbaf6a16bb303c1823</cites><orcidid>0000-0002-1279-6179 ; 0000-0002-7774-2526 ; 0000-0002-7883-8984</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935284/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935284/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33606673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Taal, Maarten W.</contributor><creatorcontrib>Ku, Elaine</creatorcontrib><creatorcontrib>Hsu, Raymond K</creatorcontrib><creatorcontrib>Johansen, Kirsten L</creatorcontrib><creatorcontrib>McCulloch, Charles E</creatorcontrib><creatorcontrib>Mitsnefes, Mark</creatorcontrib><creatorcontrib>Grimes, Barbara A</creatorcontrib><creatorcontrib>Liu, Kathleen D</creatorcontrib><title>Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US.
We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data.
In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.</description><subject>Acute renal failure</subject><subject>Adults</subject><subject>Biology and Life Sciences</subject><subject>Calendars</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Children</subject><subject>Chronic kidney failure</subject><subject>Comorbidity</subject><subject>Demographic aspects</subject><subject>Hemodialysis</subject><subject>Hispanic people</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Medicare</subject><subject>Medicine and Health Sciences</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Peritoneal dialysis</subject><subject>Peritoneum</subject><subject>Recovery of function</subject><subject>Transplants & implants</subject><subject>Trends</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk8FuEzEQhlcIREvhDRBYQkJwSFivd-01B6SoLVBUWpQQrpbXHiduN3ZYeyvyILwvTptWDcoB5IMt-5t_ZjwzWfYc50NMGH735Xw6PhudDr99PT4a4jwnVUkfZPu4KvkAU0Yf3jvvZU9CuMjzguc8f5ztEUJzShnZz36PQfkr6FbIG3RptYMVMr1T0XqHpInQIW1luwo2IOtstPL6xTqk5rbVHSTKaSR138Y1geIc0HTyHo1QB7HzYQlJ6wpQiL2-djJNKqDRJMoIAY3ByRYdySjRZBUiLJBO56fZIyPbAM82-0E2_Xj8_fDz4PT808nh6HSgGC3jQDekZgWHmkkDJdE1IdJIXvOmqoliefomUkGDC14XTUWbRhoqcdpJThSuC3KQvbzRXbY-iAvfdymaIIoqxzWrSVEn4uSG0F5eiGVnF7JbCS-tuL7w3UzILlrVgmBQ5YXmBmtcloaVHApjMFe6pJRKaJLWh423vlmAVuBiJ9st0e0XZ-di5q8E46Qq6jIJvNkIdP5nDyGKhQ0K2lY68H2Ku-SYE06rdWav_kJ3Z7ehZjIlYJ3xya9ai4oRTf2EOWNrarCDmoGDFKR3YGy63uKHO_i0NCys2mnwdssgMRF-xZnsQxAnk_F_sGf_zp7_2GZf32PnINs4D77t1-0etsHyBlSpu0MH5q6AOBfrybz9abFMpRSbyUxmL-4X_87odhTJH1hHMk8</recordid><startdate>20210219</startdate><enddate>20210219</enddate><creator>Ku, Elaine</creator><creator>Hsu, Raymond K</creator><creator>Johansen, Kirsten L</creator><creator>McCulloch, Charles E</creator><creator>Mitsnefes, Mark</creator><creator>Grimes, Barbara A</creator><creator>Liu, Kathleen D</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-1279-6179</orcidid><orcidid>https://orcid.org/0000-0002-7774-2526</orcidid><orcidid>https://orcid.org/0000-0002-7883-8984</orcidid></search><sort><creationdate>20210219</creationdate><title>Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data</title><author>Ku, Elaine ; Hsu, Raymond K ; Johansen, Kirsten L ; McCulloch, Charles E ; Mitsnefes, Mark ; Grimes, Barbara A ; Liu, Kathleen D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-db38729e87afe43d833afa989b583c7037135eb12982b56bbaf6a16bb303c1823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute renal failure</topic><topic>Adults</topic><topic>Biology and Life Sciences</topic><topic>Calendars</topic><topic>Cardiovascular disease</topic><topic>Care and treatment</topic><topic>Children</topic><topic>Chronic kidney failure</topic><topic>Comorbidity</topic><topic>Demographic aspects</topic><topic>Hemodialysis</topic><topic>Hispanic people</topic><topic>Kidney diseases</topic><topic>Kidneys</topic><topic>Medicare</topic><topic>Medicine and Health Sciences</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>People and Places</topic><topic>Peritoneal dialysis</topic><topic>Peritoneum</topic><topic>Recovery of function</topic><topic>Transplants & implants</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ku, Elaine</creatorcontrib><creatorcontrib>Hsu, Raymond K</creatorcontrib><creatorcontrib>Johansen, Kirsten L</creatorcontrib><creatorcontrib>McCulloch, Charles E</creatorcontrib><creatorcontrib>Mitsnefes, Mark</creatorcontrib><creatorcontrib>Grimes, Barbara A</creatorcontrib><creatorcontrib>Liu, Kathleen D</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ku, Elaine</au><au>Hsu, Raymond K</au><au>Johansen, Kirsten L</au><au>McCulloch, Charles E</au><au>Mitsnefes, Mark</au><au>Grimes, Barbara A</au><au>Liu, Kathleen D</au><au>Taal, Maarten W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2021-02-19</date><risdate>2021</risdate><volume>18</volume><issue>2</issue><spage>e1003546</spage><epage>e1003546</epage><pages>e1003546-e1003546</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US.
We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data.
In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33606673</pmid><doi>10.1371/JOURNAL.PMED.1003546</doi><orcidid>https://orcid.org/0000-0002-1279-6179</orcidid><orcidid>https://orcid.org/0000-0002-7774-2526</orcidid><orcidid>https://orcid.org/0000-0002-7883-8984</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acute renal failure Adults Biology and Life Sciences Calendars Cardiovascular disease Care and treatment Children Chronic kidney failure Comorbidity Demographic aspects Hemodialysis Hispanic people Kidney diseases Kidneys Medicare Medicine and Health Sciences Patient outcomes Patients People and Places Peritoneal dialysis Peritoneum Recovery of function Transplants & implants Trends |
| title | Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data |
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