In Reply to ‘Residual Kidney Function and Quality of Life in Incident Hemodialysis Patients’

Background: Residual kidney function (RKF) conveys a survival benefit among dialysis patients, but the mechanism remains unclear. Improved volume control, clearance of protein-bound and middle molecules, reduced inflammation and preserved erythropoietin and vitamin D production are among the proposed mechanisms. Preservation of RKF requires techniques to measure it accurately to be able to uncover factors that accelerate its loss and interventions that preserve it and ultimately to individualize therapy. The average of renal creatinine and urea clearance provides a superior estimate of RKF in dialysis patients, when compared with daily urine volume. However, both involve the difficult task of obtaining an accurate 24-h urine sample. Summary: In this article, we first review the definition and measurement of RKF, including newly proposed markers such as serum levels of beta2-microglobulin, cystatin C and beta-trace protein. We then discuss the predictors of RKF loss in new dialysis patients. We review several strategies to preserve RKF such as renin-angiotensin-aldosterone system blockade, incremental dialysis, use of biocompatible membranes and ultrapure dialysate in hemodialysis (HD) patients, and use of biocompatible solutions in peritoneal dialysis (PD) patients. Despite their generally adverse effects on renal function, aminoglycoside antibiotics have not been shown to have adverse effects on RKF in well-hydrated patients with end-stage renal disease (ESRD). Presently, the roles of better blood pressure control, diuretic usage, diet, and dialysis modality on RKF remain to be clearly established. Key Messages: RKF is an important and favorable prognostic indicator of reduced morbidity, mortality, and higher quality of life in both PD an HD patients. Further investigation is warranted to uncover factors that protect or impair RKF. This should lead to improved quality of life and prolonged lifespan in patients with ESRD and cost-reduction through patient centeredness, individualized therapy, and precision medicine approaches.

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P1519A TWICE-WEEKLY HEMODIALYSIS : A SINGLE CENTER STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1519 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Sirine Bchir ◽

Malek Mojaat ◽

Mariem Ben salem ◽

Boukadida Amine ◽

Insaf Handous ◽

...

Keyword(s):

Quality Of Life ◽

Kidney Function ◽

University Hospital ◽

Good Survival ◽

Biological Parameters ◽

Medical Reason ◽

Interdialytic Weight Gain ◽

Residual Kidney Function ◽

The Mean

Abstract Background and Aims Conventional hemodialysis consists of a thrice-weekly in-center Hemodialysis with a mean duration of 4 hours per session. The concept of incremental dialysis has allowed a better adjustment of its prescription guided by clinical and biological parameters. Thereby a twice-weekly regimen may maintain a good quality of life, a good survival rate and adequate dialysis in comparison to a thrice-weekly hemodialysis. The aim of our study was to investigate the profile of patients undergoing a twice-weekly regimen in our center. Method It is a monocenter transversal-descriptive study gathering patients on a twice-weekly regimen in the center of hemodialysis of Fattouma Bourguiba University Hospital in Monastir Tunisia. Results We identified 32 patients with a sex ratio of 2.2 (22 men and 10 women) with a mean age of 48,96 +/- 13,74 years. Regarding the intitial nephropathy, a chronic glomerulopathy was seen in 16 patients, a chronic tubulo-interstitial nephritis In 5 patients, and kidney polykystosis among 3 patients and in 8 patients the initial nephropathy remained undetermined. The indications for a twice-weekly HD regimen were: defavourable socio-economic conditions in 9 patients, a medical reason in 17 patients and a rejection of thrice-weekly regimen in 6 patients. The mean diuresis was 850 +/- 560 cc/24h and only one patient with anuria. The mean interdialytic weight gain was 2, 64 +/- 0, 83 Kg. Normal blood pressure and volemia were reported in 27 patients (84, 37 %). The mean number of anti-hypertensive drugs used was 1,5 per patient. The mean percentage of Urea reduction was 68, 8 % and a mean Kt/V of 1.26. The average of both kalemia and calcemia was respectively 5.27 mmol/l and 1, 94 mmol/l and the mean dosage of phosphoremia was 1, 63 mmol/l. The average of PTH and Hemoglobine was respectively 403 pg/ml and 9, 97 g/dl. Conclusion According to these results, a twice-weekly hemodialysis should be guided by the residual kidney function, clinical status (volemia), cardiovascular symptoms and comorbidities, biological parameters (Hemoglobine, potassium, phosphore) and the nutritional state. By meeting the above criteria, many studies have shown that a twice-weekly regimen or incremental dialysis help preserve the residual kidney function with a good quality of life.

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Preserving Residual Kidney Function

Kidney Protection ◽

10.1093/med/9780190611620.003.0020 ◽

2019 ◽

pp. 201-208

Author(s):

Miten J. Dhruve ◽

Joanne M. Bargman ◽

Joanne M. Bargman

Keyword(s):

Quality Of Life ◽

Peritoneal Dialysis ◽

Kidney Function ◽

Urine Volume ◽

Volume Control ◽

Dialysis Patients ◽

Renin Angiotensin Aldosterone System ◽

Residual Kidney Function ◽

Transplant Kidney

Residual kidney function is strongly associated with benefits in survival, morbidity, and quality of life in both hemodialysis and peritoneal dialysis patients. Possible explanations include better volume control in dialysis patients who maintain significant urine volume, better middle molecule and other toxin clearance by the kidneys, and a lower level of systemic inflammation associated with ongoing kidney function. The residual kidney function should be monitored and preserved if at all possible. Practices such as incremental dialysis, avoidance of interim hemodialysis in those choosing peritoneal dialysis, avoidance of peritonitis and nephrotoxic medications, use of renin–angiotensin–aldosterone system blockade, and maintenance of transplant kidney function with ongoing low-level immunosuppression are all methods that can be implemented to help protect this vital function.

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