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PLoS One. 2013 Dec 17;8(12):e83447. doi: 10.1371/journal.pone.0083447. eCollection 2013.

Recovery of renal function among ESRD patients in the US medicare program.

Author information

  • 1Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York, United States of America.
  • 2Division of Quality Improvement, Centers for Medicare & Medicaid Services, Boston Regional Office, Boston, Massachusetts, United States of America.
  • 3Division of Nephrology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America.
  • 4Division of Vascular Surgery, Department of Surgery, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America.
  • 5Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States of America.
  • 6Division of Nephrology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, United States of America.



Patients started on long term hemodialysis have typically had low rates of reported renal recovery with recent estimates ranging from 0.9-2.4% while higher rates of recovery have been reported in cohorts with higher percentages of patients with acute renal failure requiring dialysis.


Our analysis followed approximately 194,000 patients who were initiated on hemodialysis during a 2-year period (2008 & 2009) with CMS-2728 forms submitted to CMS by dialysis facilities, cross-referenced with patient record updates through the end of 2010, and tracked through December 2010 in the CMS SIMS registry.


We report a sustained renal recovery (i.e no return to ESRD during the available follow up period) rate among Medicare ESRD patients of > 5% - much higher than previously reported. Recovery occurred primarily in the first 2 months post incident dialysis, and was more likely in cases with renal failure secondary to etiologies associated with acute kidney injury. Patients experiencing sustained recovery were markedly less likely than true long-term ESRD patients to have permanent vascular accesses in place at incident hemodialysis, while non-White patients, and patients with any prior nephrology care appeared to have significantly lower rates of renal recovery. We also found widespread geographic variation in the rates of renal recovery across the United States.


Renal recovery rates in the US Medicare ESRD program are higher than previously reported and appear to have significant geographic variation. Patients with diagnoses associated with acute kidney injury who are initiated on long-term hemodialysis have significantly higher rates of renal recovery than the general ESRD population and lower rates of permanent access placement.

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