Cessation of Hemodialysis Among End-Stage Kidney Disease Patients Following Recovery of Kidney Function

Background: Recovery of kidney function (RKF) among end-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) is uncommon and has not been reported from Pakistan. Objective: To identify ESKD patients who discontinued MHD following RKF. Methods: This retrospective cross-sectional study was conducted at Shahida Islam Medical College, Lodhran, and Bahawal Victoria Hospital, Bahawalpur, Pakistan, from January 2022 to January 2025. The study included ESKD patients aged ≥18 years on MHD for at least 6 months. The records of ESKD patients who were discharged from dialysis services were reviewed to identify patients with RKF and the data of patients with RKF who remained dialysis-free for at least 6 months. Results: There were 932 ESKD patients with a mean age of 44.63±16.74 years, on MHD for ≥6 months. A total of 484 patients were discharged from the dialysis centers. Out of 484 patients, 118 (12.7%) patients died, 26 (2.8%) underwent kidney transplant, none of them switched to PD, 39 (4.2%) voluntarily withdrew from dialysis and were lost to follow-up, and 295(31.6%) were transferred. There were 6 patients (0.64%) who had RKF and were dialysis-free for ≥6 months. The cause of ESKD among these 6 patients with RKF was unknown in four patients, whereas one had a cause of diabetes mellitus and one had chronic tubulointerstitial nephritis. In patients who had RKF, two died, two remained dialysis-free until last follow-up, one re-started MHD, and one had a kidney transplant. Conclusion: RKF is an uncommon but unexplored phenomenon among our ESKD patients. Objective assessment of residual kidney function and clinical assessment is paramount in considering RKF among ESKD patients on MHD. These patients need close monitoring and regular follow-up.