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1 Australia and New Zealand Dialysis and Transplant Registry, Adelaide; 2 Department of Renal Medicine, Princess Alexandra Hospital, Brisbane;3 Department of Nephrology and Transplantation Services, the Queen Elizabeth Hospital, and University of Adelaide, Adelaide, Australia; 4 Renal Department, Middlemore Hospital, Otahuhu, Auckland, New Zealand; 5 Department of Nephrology, Monash Medical Center, Clayton, Victoria, Australia
Correspondence to: D. Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia. david_johnson{at}health.qld.gov.au
Objectives: The aim of this study was to investigate the
factors affecting recovery and durability of dialysis-independent renal
function following commencement of peritoneal dialysis (PD). Design: Retrospective, observational cohort study of the
Australian and New Zealand PD patient population. Setting: Australia and New Zealand Dialysis and Transplant
(ANZDATA) Registry. Participants: The study reviewed all patients in Australia
and New Zealand who commenced PD for treatment of end-stage renal failure
between 15 May 1963 and 31 December 2004. Main Outcome Measures: The primary outcomes examined were
recovery of dialysis-independent renal function and time from PD commencement
to recovery of renal function. A secondary outcome measure was time to renal
death (patient death or recommencement of renal replacement therapy) following
recovery of dialysis-independent renal function. Results: 24663 patients commenced PD during the study
period. Of these, 253 (1%) recovered dialysis-independent renal function. An
increased likelihood of recovery was predicted by autoimmune renal disease,
hemolytic-uremic syndrome, paraproteinemia, cortical necrosis, renovascular
disease, and treatment in New Zealand. A reduced likelihood of recovery was
associated with polycystic kidney disease and indigenous race. Analysis of a
contemporary subset of 14743 patients in whom complete data were available for
body mass index, smoking, and comorbidities yielded comparable results, except
that increasing age was additionally associated with a decreased likelihood of
recovery. Of the 253 patients who recovered renal function, 151 (60%)
recommenced renal replacement therapy and 49 (19%) died within a median period
of 226 days (interquartile range 110-581 days). The only significant
predictors of continued renal survival after renal recovery were autoimmune
renal disease and cortical necrosis. Conclusions: Recovery of renal function in patients
treated with PD is rare and determined mainly by renal disease type and race.
In the majority of cases, recovery is short term. The apparently high rate of
early patient death or return to dialysis after recovery of renal function on
PD raises questions about the appropriateness of discontinuing PD therapy
under such circumstances.
KEY WORDS: KEY WORDS:; End-stage renal failure; kidney failure, chronic; outcomes; renal function recovery; residual renal function.
Received 7 August 2006; accepted 20 October 2006.
This article has been cited by other articles:
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  J. A. Macdonald, S. P. McDonald, C. M. Hawley, J. Rosman, F. Brown, K. J. Wiggins, K. Bannister, and D. W. Johnson Recovery of renal function in end-stage renal failure--comparison between peritoneal dialysis and haemodialysis Nephrol. Dial. Transplant., May 14, 2009; (2009) gfp216v1. [Abstract] [Full Text] [PDF]
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