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NDT Advance Access originally published online on May 14, 2009
Nephrology Dialysis Transplantation 2009 24(9):2825-2831; doi:10.1093/ndt/gfp216
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Recovery of renal function in end-stage renal failure—comparison between peritoneal dialysis and haemodialysis

James A. Macdonald1,2, Stephen P. McDonald1,3, Carmel M. Hawley1,2, Johan Rosman1,4, Fiona Brown1,5, Kathryn J. Wiggins1,6, Kym Bannister1,7 and David W. Johnson1,2

1 ANZDATA Registry, Adelaide 2 Department Renal Medicine, Princess Alexandra Hospital, Brisbane 3 Department of Nephrology and Transplantation services, the Queen Elizabeth Hospital, Adelaide, Australia 4 Renal Department, Middlemore Hospital, Auckland, New Zealand 5 Department of Nephrology, Monash Medical Centre, Melbourne 6 Department of Medicine, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria 7 Department of Nephrology, Royal Adelaide Hospital, Adelaide, Australia

Correspondence and offprint requests to: David W. Johnson; E-mail: david_johnson{at}health.qld.gov.au



  Abstract

Background. Recovery of dialysis-independent renal function in long-term dialysis patients has not been studied extensively. The aim of this study was to investigate the effect of dialysis modality on the likelihood, timing and durability of recovery of dialysis-independent renal function.

Methods. The study reviewed all patients in Australia and New Zealand who commenced dialysis for treatment of end-stage renal disease (ESRD) between 1963 and 2006. Dialysis modality was assigned at 90 days. A supplementary analysis was also conducted using a contemporary cohort that included data on comorbidities, smoking and eGFR at dialysis onset.

Results. During the study period, 15 912 individuals received peritoneal dialysis (PD) and 23 658 received haemodialysis (HD). Renal recovery occurred in 176 (1.1%) PD and 244 (1.0%) HD patients. Using multivariate Cox proportional hazards regression analyses, dialysis modality was not independently predictive of time to renal recovery (HR 0.92, 95% CI 0.76–1.13, P = 0.4). Recovery was significantly more likely in patients with higher baseline eGFR, with no hypertension or peripheral vascular disease, and with certain causes of kidney failure (autoimmune renal disease, haemolytic uraemic syndrome, interstitial nephritis, obstructive uropathy, paraproteinaemia and renovascular nephrosclerosis). Recovery was less likely in Maori/Pacific Islanders and polycystic kidney disease. Among patients who recovered, 328 (78%) subsequently experienced renal death, mostly within the first year. The duration of renal recovery was not associated with initial dialysis modality (OR 0.82, 95% CI 0.50– 1.32).

Conclusions. Dialysis modality is not associated with the likelihood, timing or durability of spontaneous recovery of dialysis-independent renal function in patients thought to have ESRD.

Keywords: continuous ambulatory peritoneal dialysis; end-stage renal disease; haemodialysis; outcomes; residual renal function

Received for publication: 23.12.08
Accepted in revised form: 20. 4.09


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