Anyone (Dori, Beth?) have any comments on this abstract from the upcoming ASN conference? On face value the recovery of renal function is a bit startling, even though we are only talking ~5% of the patients. Obviously this is relatively small #, but it’s not just a random anecdote either. I’m surprised this is not going to be discussed at the conference (apparently not even presented in poster form). The cynic in me suspects that these data are not featured for discussion as they would not be warmly received by the folks that run and own the dialysis clinics - it’s bad for business when your clients don’t need your service anymore!
[PUB387] Recovery of Renal Function Noted in a Short Daily Low Volume Dialysate Home Dialysis Program
Michael A. Kraus, Patti G. Christ, Rita J. Blevens, Connie Summitt, Sharon Ayers, Karen Sumners, Sharon Myers, Sandra Wood, Cathy Cox Department of Medicine, Indiana University, Indianapolis, IN; Home Dialysis, Clarian Health Partners, Indianapolis, IN
Clarian Health Partners and Indiana University have developed a home dialysis program using increased frequency low volume short daily dialysis (SDHD). Review of loss of patients (pts) from the program have revealed a high percentage of pts who have terminated therapy due to recovery of renal function.
The SDHD program was begun in March of 2004. In the first 6 months patient recruitment to the program was limited to the original IDE study (9 pts). After October of 2004 the program was opened to the general ESRD population. We have trained 111 pts from March 2004 to June 2008. 51 pts were referred from an IU nephrologist, 8 pts from an outside nephrologist, and 52 self-referrals. 6 pts have not completed training - 3 returned to intermittent hemodialysis (IHD) by choice, 2 failed to train due to acute medical illness and death, and 1 received transplantation (tx).
Of 111 pts, 56 are on therapy today. 4 perform in-center SDHD, 50 are at home and 2 are in training. Reasons for discontinuation of therapy are: 9 tx, 6 transfer to another SDHD unit, 18 Death, 16 return to IHD or PD (10 patient, 6 partner). In addition 6 pts have recovered enough renal function (RRF) to survive without renal replacement therapy.
Of these 6 patients -
4 remain off dialysis
1 cancer death with recovery of renal function (RRF)
1 return to SDHD after 3 months
Diagnosis of ESRD: Myeloma post BMtx (2); Sepsis (1); Sudden death with DM (1);CHF (1); and post AAA repair (1).
Total months of ESRD / ESRD pre SDHD / SDHD before stopping SDHD were:
- 19 / 10 / 9
- 15 / 10 / 5
- 29 / 3 / 26
- 15 / 2 / 13
- 17.5 / 17 / 0.5
- 10 / 4 / 6
Pts have remained off dialysis for:
- 3 months (return to SDHD)
- 1 year (non-renal death)
- still off HD for 35, 13, 10 and 1 month all with S Cr < 3.0 mg/dl.
6 of 111 pts treated with SDHD in our institution have regained RRF - 4 for >10 months. This high rate of regain of RRF suggests that SDHD might allow for renal recovery at a rate higher than reported in the USRDS.
Further, pts with ESRD should be monitored for RRF and taken off IHD when appropriate.