Renal Recovery and Survival in Patients Requiring Hemodialysis at Presentation for Rapidly Progressive Glomerulonephritis: A 10-Year Single-Center Experience

Abstract

Objective: Patients with rapidly progressive glomerulonephritis (RPGN) requiring hemodialysis at presentation constitute a high-risk population with poor renal and patient outcomes. The authors aimed to evaluate renal recovery, long-term outcomes, and factors associated with dialysis independence in patients presenting with dialysis-requiring RPGN. Methods: This retrospective single-center study included 31 consecutive patients with RPGN requiring renal replacement therapy at presentation between January 2015 and March 2025. Demographic, clinical, laboratory, histopathological, treatment, and outcome data were collected and analyzed. The primary outcome was dialysis independence at hospital discharge. Results: The median age was 52 years (interquartile range [IQR], 30-66), and ANCA-associated vasculitis was the predominant etiology (71%). At hospital discharge, 9 patients (29.0%) achieved dialysis independence, 16 (51.6%) remained dialysis dependent, and 6 (19.4%) died during hospitalization. After a median follow-up of 21.5 months, 41.9% required ongoing renal replacement therapy, and overall mortality was 32.2%. Exploratory receiver operating characteristic (ROC) analysis showed discriminatory ability of admission serum creatinine for dialysis independence (AUC, 0.79; 95% CI: 0.63-0.96; P = .01), with a ROC-derived cutoff of 4.32 mg/dL. In univariate analysis, admission serum creatinine <4.32 mg/dL (OR, 9.33; 95% CI: 1.36-63.95; P = .02) and a pan-immune-inflammation value (PIV) <93.5 (OR, 11.14; 95% CI: 1.10-112.01; P = .04) were significantly associated with dialysis independence. Conclusions: Renal recovery remains achievable in a subset of patients with dialysis-requiring RPGN despite severe kidney dysfunction at presentation. Lower admission serum creatinine and lower PIV were associated with dialysis independence in univariate analyses; however, these findings should be considered exploratory and hypothesis-generating rather than clinically validated predictors. The high rates of long-term renal replacement therapy and mortality underscore the poor prognosis of dialysis-requiring RPGN. Larger prospective multicenter studies are needed to validate these associations and better define factors associated with renal recovery in this high-risk population.     Cite this article as: Alan AM, Cerme MO, AR MC, Trabulus S. Renal recovery and survival in patients requiring hemodialysis at presentation for rapidly progressive glomerulonephritis: a 10-year single-center experience. Cerrahpaşa Med J 2026, 50, 0113, doi: 10.5152/cjm.2026.26113.