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Peritoneal Dialysis May Be More Likely To Achieve Renal Function Recovery In Atheroembolic Renal Failure

Patients with atheroembolic renal failure have a high mortality rate, but also have a greater chance of recovering renal function than with other vascular causes of renal failure, a Canadian study has concluded.

The study found recovery of renal function, to the extent that dialysis was no longer necessary, was an important predictor of survival. In contrast, intermittent claudication was associated with non-recovery of renal function.

Researchers from the University of Montreal, Quebec, Canada, led by Dr Josée Thériault, reviewed all cases of atheroembolic renal failure requiring dialysis, at 2 institutions, between January 1984 and December 2000. Of the 43 cases identified, 12 recovered renal function enough to continue dialysis (after a mean delay of 409 days) and 31 did not.

Those who recovered renal function had a mean survival time of 2,857 days, compared with 1,542 days in those who remained dialysis dependent. If intermittent claudication was present, the average delay before dialysis could be halted was 2,785 days, compared with 748 days in the absence of intermittent claudication. Increased baseline creatinine levels and more severe hypertension were the only other two factors to be associated with sustained dependence on dialysis. Thirty-three percent of patients died in the first year of follow up.

Patients in the study underwent intermittent haemodialysis, continuous renal replacement therapy or peritoneal dialysis. Of the 10 patients undergoing peritoneal dialysis (3 patients were started on it and a further 7 were transferred to it from haemodialysis), 5 recovered sufficient renal function to enable dialysis to be halted. This represented 41.7% of the total number of patients in the study who recovered renal function.

The high recovery rate in this subgroup, relative to other types of renal replacement therapy, "could represent an advantageous dialytic modality" the researchers said. Haemodialysis involved systemic anticoagulation using heparin, which could promote atheroembolism. This, the researchers suggested, might explain the lower recover rate in that group relative to the peritoneal-dialysis group. However, they noted that "the study was rather small" and "further studies are needed to confirm our observation."
Nephron Clin Pract 2003;94:1:c11-c18. "Atheroembolic Renal Failure Requiring Dialysis: Potential for Renal Recovery?"

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