Do you have any patients with recovery of ESRD after dialysis?
I have two patients with ESRD that they became dialysis free after a few months.
It depends on what you are subjecting the patient to dialysis for. Theoretically, there is no recovery if patient is in end stage. By definition, it is an irreversible process. But if at the time you review your patient and the patient has severe renal functional derangement because of acute insult on a chronically mild renal impairment, this will give a false picture of ESRD, therefore dialysis will restore renal function to the pre-acute insult stage. So it is clear why such patient will become dialysis free.
Cardiorenal syndrome is one of the conditions, when kidney function can improve during regular dialysis treatment in some patients.
Yes tihis is possible I had a patient recovered from HD after ten years of HD
Evidences suggest better RRF preservation in patients on PD versus HD. However, evidences available through various studies still do not comment anything conclusively on renal recovery. However,clinical practice may show variable results. Further studies and discussions are awaited.
Yes, I have 4 to 6 patients who recovered their renal function. A couple were pre-ESRD and their renal improved shortly after the access was formed or placed. A few were already on HD or PD and their renal function improved. Should I call it the "Miracle of the dialysis access"? I really don't know the answer to what causes the renal function improvement, but I do encourage all of my patients to follow the instructions and recommendations of their nephrologist and nutritionist and take their medications unless instructed otherwise.
Yes in case of AKI overlap due to various reasons,i.e sepsis. Therfore, it is mandatory for all dialysis Units Doctors to look periodically for any improvment in patients' serum creatinins and urine volums.
Dear Colleagues
Thanks a lot for your useful answers and recommendations .
To Craig: Not only miracle, but scientifically proved fact:
"Arteriovenous fistula as a nephroprotective intervention in advanced CKD: scientific discovery and explanation, and the evaluation of interventions"
http://ndt.oxfordjournals.org/content/early/2015/08/01/ndt.gfv281.extract
Article Arteriovenous fistula as a nephroprotective intervention in ...
In our experience , 7 of 194 patients ( 3.6% ) undergoing dialysis for severe CKD had recovery of renal function & could be weaned of dialysis . It is probable that there was AKI ON CKD , though we could not identify any risk factors . The diagnosis of ESRD , should be made only after a period of dialysis . It is difficult in some patients to determine , whether it is AKI , CKD or AKI on CKD .
The references are given below
1) Recovery of renal function in patients with End-stage Renal failure . JAPI 32(7) 1984
2) Management of Renal failure in India . A strategy based on peritoneal dialysis .JAPI , 33 (IO) : 647-9 ,1985.
These articles are available in RG under my articles for your reference .
I also agree with Biswajit Sarkar that renal function is better on PD than HD & this has also been our experience in which patients on PD recovered their function in severe CKD compared with HD . This was just an observation & we did not publish this experience .
Up to 1-5% of all patients who start dialysis for any reason may "recover".
J Am Soc Nephrol 18: 2189–2197, 2007. doi: 10.1681/ASN.2007010066
doi:10.4061/2010/817836
http://www.biomedcentral.com/1471-2369/4/9
If the Kidneys have reduced in size in a Patient. Is it possible that Patient could recover from Dialysis?
If the kidney is reduced in size , it suggests CKD , but function of these kidneys can be different with good function from stage 2 to stage 5 CKD & recovery can occur due to associated AKI .
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