title: Recovery of renal function among ESRD patients in the US medicare program.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York, United States of America.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Division of Quality Improvement, Centers for Medicare & Medicaid Services, Boston Regional Office, Boston, Massachusetts, United States of America.
authors.forename: Edwin
authors.initials: E
authors.lastname: Huff
authors.affiliation: Division of Nephrology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Jay
authors.initials: J
authors.lastname: Wish
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Lilly
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States of America.
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology* / Q000534:rehabilitation*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D020127:Recovery of Function; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology