scholarly journals Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

2016 ◽  
Vol 68 (2) ◽  
pp. 256-265 ◽  
Author(s):  
Yoshitsugu Obi ◽  
Elani Streja ◽  
Connie M. Rhee ◽  
Vanessa Ravel ◽  
Alpesh N. Amin ◽  
...  
Author(s):  
L. Surzhko

The work is a literature review. Residual kidney function (RKF) is one of the crucial indicators of mortality and quality of life in patients with chronic kidney disease. Residual renal function provides better control of hydration, blood pressure, clearance of substances with low and middleweight, anemia, Ca/P metabolism, chronic inflammation. However, approaches to preservation of RKF in dialysis patients have been studied not enough, the importance of RKF preservation is underlined. The wide range of predictors of RKF loss are presented in the article, approaches to measurement of RKF, the relationship between level and presence of RKF with survival and mortality of patients with CKD 5D were analyzed. The possibility of RKF preservation and extension using different approaches by correction of dialysis prescription were estimated. There is no standardized method for applying incremental hemodialysis in practice. Onceto twice-weekly hemodialysis regimens are often used randomly, without knowing the benefit for current patient or how to escalate the dialysis dose if RKF declines over time. It is important to change the HD/HDF prescription according to the range of RRF using objective data.


2019 ◽  
Vol 1 (3) ◽  
pp. 104-114 ◽  
Author(s):  
Dominik Steubl ◽  
Li Fan ◽  
Wieneke M. Michels ◽  
Lesley A. Inker ◽  
Hocine Tighiouart ◽  
...  

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Sirayut Phatthanasobhon ◽  
Surapon Nochaiwong ◽  
Kednapa Thavorn ◽  
Kajohnsak Noppakun ◽  
Setthapon Panyathong ◽  
...  

AbstractWe performed a network meta-analysis of randomised controlled trials (RCTs) and non-randomised studies in adult peritoneal dialysis patients to evaluate the effects of specific renin-angiotensin aldosterone systems (RAAS) blockade classes on residual kidney function and peritoneal membrane function. Key outcome parameters included the following: residual glomerular filtration rate (rGFR), urine volume, anuria, dialysate-to-plasma creatinine ratio (D/P Cr), and acceptability of treatment. Indirect treatment effects were compared using random-effects model. Pooled standardised mean differences (SMDs) and odd ratios (ORs) were estimated with 95% confidence intervals (CIs). We identified 10 RCTs (n = 484) and 10 non-randomised studies (n = 3,305). Regarding changes in rGFR, RAAS blockade with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were more efficacious than active control (SMD 0.55 [0.06–1.04] and 0.62 [0.19–1.04], respectively) with the protective effect on rGFR observed only after usage ≥12 months, and no differences among ACEIs and ARBs. Compared with active control, only ACEIs showed a significantly decreased risk of anuria (OR 0.62 [0.41–0.95]). No difference among treatments for urine volume and acceptability of treatment were observed, whereas evidence for D/P Cr is inconclusive. The small number of randomised studies and differences in outcome definitions used may limit the quality of the evidence.


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