Importance of Residual Renal Function in End-Stage Renal Disease

Abstract : Introduction: Peritoneal dialysis (PD) is as effective as hemodialysis and often provides a better quality of life for patients. Despite this, the replacement therapy remains little established in our country with a prevalence of less than 1% of patients with end-stage renal disease. The objective of this work is to report the development and complications of PD in our center. Patients and methods: This is a retrospective study including all patients on PD between October 2008 and March 2019. We noted their demographic and clinical data at their initiation in peritoneal dialysis and we followed their evolution to discuss infectious and mechanical complications as well as the causes of PD exit. Results: During the study period, 456 patients were admitted for end-stage renal disease. Among these patients, only 28 (6.1%) were put on PD including two diabetics. Their average age was 37.7 years with a sex ratio of 0.8. The average body surface area was 1.59 m² with an average residual renal function of 6.05 ml / min. PD was chosen as the first intention in 20 patients while 8 patients were on hemodialysis. The evolution was marked by a median survival of the technique of 18.5 months characterized by 8 episodes of peritonitis in 4 patients corresponding to a rate of 1 episode over 56 months. Regarding mechanical complications, we noted 9 omentum aspirations, 1 leak in one case and 1 umbilical hernia requiring surgical recovery in a patient. Out of 28 patients, 17 discharges were identified; 10 patients (67%) were transferred to hemodialysis, 4 died and only 3 patients (18%) were transplanted. The final transfer to hemodialysis was related to mechanical complications in 5 cases, loss of ultrafiltration in one case, repeated hydro-sodium overload in one case, peritonitis in one case and social reasons in two cases. Conclusion: PD is an effective technique which preserves residual renal function and quality of life but its prevalence remains low in the order of 6% of patients treated for end-stage renal disease. The complications are dominated in our context by the mechanical complications main cause of final transfer in hemodialysis.

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Predictors of Loss of Residual Renal Function among New Dialysis Patients

Journal of the American Society of Nephrology ◽

10.1681/asn.v113556 ◽

2000 ◽

Vol 11 (3) ◽

pp. 556-564 ◽

Cited By ~ 10

Author(s):

LOUISE M. MOIST ◽

FRIEDRICH K. PORT ◽

SEAN M. ORZOL ◽

ERIC W. YOUNG ◽

TRULS OSTBYE ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Residual Renal Function ◽

Prior History ◽

History Of ◽

Stage Renal Disease ◽

End Stage

Abstract. Residual renal function (RRF) in end-stage renal disease is clinically important as it contributes to adequacy of dialysis, quality of life, and mortality. This study was conducted to determine the predictors of RRF loss in a national random sample of patients initiating hemodialysis and peritoneal dialysis. The study controlled for baseline variables and included major predictors. The end point was loss of RRF, defined as a urine volume <200 ml/24 h at approximately 1 yr of follow-up. The adjusted odds ratios (AOR) and P values associated with each of the demographic, clinical, laboratory, and treatment parameters were estimated using an “adjusted” univariate analysis. Significant variables (P < 0.05) were included in a multivariate logistic regression model. Predictors of RRF loss were female gender (AOR = 1.45; P < 0.001), non-white race (AOR = 1.57; P = <0.001), prior history of diabetes (AOR = 1.82; P = 0.006), prior history of congestive heart failure (AOR = 1.32; P = 0.03), and time to follow-up (AOR = 1.06 per month; P = 0.03). Patients treated with peritoneal dialysis had a 65% lower risk of RRF loss than those on hemodialysis (AOR = 0.35; P < 0.001). Higher serum calcium (AOR = 0.81 per mg/dl; P = 0.05), use of an angiotensin-converting enzyme inhibitor (AOR = 0.68; P < 0.001), and use of a calcium channel blocker (AOR = 0.77; P = 0.01) were independently associated with decreased risk of RRF loss. The observations of demographic groups at risk and potentially modifiable factors and therapies have generated testable hypotheses regarding therapies that may preserve RRF among end-stage renal disease patients.

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