Definition and Risk Factors of Rapidly Declining Residual Renal Function in Peritoneal Dialysis: An Observational Study

Background: This study analysed children with end-stage renal disease treated with automated peritoneal dialysis (APD) in our centre to explore the risk factors associated with residual renal function (RRF) loss. Methods: Children treated with APD as the initial renal replacement therapy regimen from January 2008 to December 2016 were included. All the children had a daily urine volume of ≥100 ml/m2 when APD was initiated and a dialysis follow-up time of ≥12 months. A daily urine volume of <100 ml/m2 after 12 months of APD treatment was defined as loss of RRF. Possible risk factors that may be associated with RRF loss were analysed. Results: A total of 66 children were included in the study. After 12 months of APD treatment, the daily urine volume decreased by 377.45 ± 348.80 ml/m2, the residual glomerular filtration rate decreased by 6.39 ± 3.69 ml/min/1.73 m2 and 29 of the patients (43.9%) developed RRF loss. The higher risk of RRF loss after 1 year of APD treatment was most pronounced in patients with daily urine volume of ≤400 ml/m2 before treatment, higher glucose exposure and higher ultrafiltration volume, while the lower risk of RRF loss was in patients with administration of diuretics. Each increase of 1 g/m2/day glucose exposure was associated with a 5% increase in RRF loss (odds ratio (OR) 1.05, p = 0.023) and each increase of 1 ml/m2/day ultrafiltration volume was associated with a 1% increase in RRF loss (OR 1.01, p = 0.013). Conclusion: In children undergoing APD, the risk for loss of RRF is associated with low urine volume at the start of APD, high glucose loading and high peritoneal ultrafiltration volume, while preservation of RRF is associated with the usage of diuretics.

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Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

Peritoneal Dialysis International ◽

10.1177/089686080202200312 ◽

2002 ◽

Vol 22 (3) ◽

pp. 371-379 ◽

Cited By ~ 45

Author(s):

◽

Michael V. Rocco ◽

Diane L. Frankenfield ◽

Barbara Prowant ◽

Pamela Frederick ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Renal Function ◽

Peritoneal Dialysis ◽

Serum Albumin ◽

Creatinine Clearance ◽

Residual Renal Function ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

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Rate of Decline of Residual Renal Function in Patients on Continuous Peritoneal Dialysis and Factors Affecting It

Peritoneal Dialysis International ◽

10.1177/089686080002000410 ◽

2000 ◽

Vol 20 (4) ◽

pp. 429-438 ◽

Cited By ~ 91

Author(s):

Manoj K. Singhal ◽

Shaunmukhum Bhaskaran ◽

Edward Vidgen ◽

Joanne M. Bargman ◽

Stephen I. Vas ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Multivariate Analysis ◽

Peritoneal Dialysis ◽

Creatinine Clearance ◽

Outcome Measure ◽

Residual Renal Function ◽

Left Ventricular ◽

Male Gender

Objective We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. Study Design Single-center, prospective cohort study. Setting Home PD unit of a tertiary care University Hospital. Patients The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. Measurement All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. Outcome Measure The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. Results There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate ( p = 0.0001), higher rate of peritonitis ( p = 0.0005), higher use of AG ( p = 0.0006), presence of diabetes mellitus ( p = 0.005), larger body mass index (BMI) ( p = 0.01), and no use of antihypertensive medications ( p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. Conclusion Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.

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Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis

Kidney International ◽

10.1038/ki.2015.108 ◽

2015 ◽

Vol 88 (3) ◽

pp. 605-613 ◽

Cited By ~ 19

Author(s):

Il-Soo Ha ◽

Hui K. Yap ◽

Reyner L. Munarriz ◽

Pedro H. Zambrano ◽

Joseph T. Flynn ◽

...

Keyword(s):

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Chronic Peritoneal Dialysis

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Risk Factors Influencing the Decline of Residual Renal Function in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686089901900211 ◽

1999 ◽

Vol 19 (2) ◽

pp. 138-142 ◽

Cited By ~ 45

Author(s):

Sug Kyun Shin ◽

Hyunjin Noh ◽

Shin Wook Kang ◽

Bo Jung Seo ◽

In Hee Lee ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Renal Function ◽

Risk Factor ◽

Peritoneal Dialysis ◽

Independent Risk Factor ◽

Residual Renal Function ◽

Logarithmic Scale ◽

Linear Scale ◽

Factors Influencing

Objective To assess the nature of the decline in residual renal function (RRF) after the initiation of peritoneal dialysis, and to identify risk factors influencing the preservation of RRF. Design A retrospective single-center study. Setting Tertiary medical center. Patients Eighty patients who were clinically stable and had been on continuous ambulatory peritoneal dialysis (CAPD) for a minimum of 6 months. Main Outcome Measures All subjects had at least three measurements of RRF, which was calculated as the average of creatinine clearance (Ccr) and urea clearance from a 24-hour urine collection. All measurements of RRF were plotted on a logarithmic scale and a linear scale against the duration of CAPD. Covariables used in the correlation analyses were age, sex, the presence of diabetes mellitus, mean blood pressure, mean diastolic blood pressure, hematocrit and Ccr at the start of peritoneal dialysis, peritoneal membrane transport characteristics by peritoneal equilibration test (PET), and the rate of peritonitis. Results A significant correlation was found between CAPD duration and RRF decline represented on a logarithmic scale with a correlation coefficient ( r) of 0.355 ( p < 0.001). In contrast, on a linear scale, the correlation coefficient was only 0.273 ( p < 0.01). By linear multiple regression analysis, the only independent risk factor for the decline of RRF was the rate of peritonitis ( r = -0.446, p < 0.001). Conclusion These results suggest that RRF declines exponentially rather than linearly with time, and that the rate of peritonitis is an independent risk factor for the decline of RRF in CAPD patients.

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Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00123 ◽

2016 ◽

Vol 36 (6) ◽

pp. 669-675 ◽

Cited By ~ 1

Author(s):

Maria Roszkowska-Blaim ◽

Piotr Skrzypczyk

Keyword(s):

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Univariate Analysis ◽

Residual Renal Function ◽

Fluid Volume ◽

First Year ◽

Z Score ◽

Glucose Load ◽

Second Year

Background The aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD). Methods The study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m2/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m2]), etiology of ESRD, PD fluid volume (mL/m2/24 h), glucose load (g/m2/24 h), ultrafiltration (mL/m2/24 h), peritoneal permeability (D/PCrea 4h, D/D0 Glu 4h), dialysis adequacy (twKt/V, twCCr [L/week/1.73 m2]), blood pressure (BP), biochemical parameters, and medications used. Duration of follow-up was 24 months. Results Mean diuresis before initiation of PD was 1,394.93 ± 698.37 (mL/m2/24 h), and mean rGFR was 7.41 ± 3.96 (mL/min/1.73 m2). The rate of daily diuresis decline was -529.34 ± 546.28 in the first year and -107.10 ± 291.54 (mL/m2/24 h) in the second year ( p = 0.005), and the rate of rGFR decline was -3.35 ± 3.73 in the first year and -1.63 ± 1.85 (mL/min/1.73 m2) in the second year ( p = 0.118). Eleven (19.64%) patients became anuric. In univariate analysis, the rate of daily diuresis decline in the first year was related to baseline diuresis ( r = -0.29, p = 0.031), proteinuria ( r = -0.43, p = 0.001), and systolic BP ( r = -0.31, p = 0.020); 12-month changes (Δ0 - 12) in PD fluid volume ( r = -0.37, p = 0.004), glucose load ( r = -0.28, p = 0.035), and ultrafiltration ( r = -0.38, p = 0.004); serum calcium-phosphorus product ( r = -0.41, p = 0.002); and Δ0 - 12 body mass index (BMI) Z-score ( r = 0.30, p = 0.024); while the rate of rGFR decline in the first year was related only to baseline rGFR ( r = -0.57, p < 0.001). In multivariate analysis, significant predictors of the rate of daily diuresis decline in the first year were baseline diuresis (P = -0.386, p < 0.001) and proteinuria (p = -0.278, p = 0.017), mean systolic BP Z-score (P = -0.237, p = 0.027), and age at the onset of PD (P = -0.224, p = 0.037), while predictors of the rate of rGFR decline were baseline rGFR (P = -0.607, p < 0.001) and baseline proteinuria (P = -0.225, p = 0.046). In the second year, the only predictors of the rate of rGFR decline were D/D0 Glu 4h ( r = 0.44, p = 0.033, univariate analysis) and rGFR at 12 months (P = -0.499, p = 0.044). Conclusion The most important risk factors for rapid RRF decline in children during the first year of chronic PD include higher baseline daily diuresis and proteinuria, and additional factors are systolic BP and age at the onset of PD; while high baseline GFR and low peritoneal transport status may be the only important factors during the second year.

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Rapid Change in Residual Renal Function Decline is Associated with Lower Survival and Worse Residual Renal Function Preservation in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00211 ◽

2017 ◽

Vol 37 (4) ◽

pp. 477-481 ◽

Cited By ~ 6

Author(s):

Susie L. Hu ◽

Priyanka Joshi ◽

Mark Kaplan ◽

Judy Lefkovitz ◽

Andreea Poenariu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Fold Increase ◽

Residual Renal Function ◽

Rapid Decline ◽

Dialysis Patients ◽

Risk Of Mortality ◽

Increased Risk

The survival advantage observed among peritoneal dialysis patients early on after dialysis initiation has been largely attributed to residual renal function (RRF) preservation due to higher baseline residual function and fewer comorbidities. We hypothesize that a rapid decline in RRF is associated with higher risk of anuria and mortality. In a retrospective cohort study of 581 subjects on peritoneal dialysis with longitudinal prevalent data, we assessed whether RRF change over time, in addition to baseline RRF, increased risk of mortality and anuria using Kaplan-Meier analysis and Cox proportional hazard analysis to control for known risk factors. Rapid RRF decline (≥ 0.09 decline) over a 12-month period was associated with a 2.6-fold increase in the risk of death (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.66 – 4.07, compared with < 0.09 decline) and a 2-fold increase in anuria (HR 2.06, 95% CI 1.24 – 3.42). Each quartile of increasing severity of RRF decline over a 12-month period increased risk incrementally for death (2ndquartile: HR 3.04, CI 1.26 – 7.34; 3rdquartile: HR 4.01, CI 1.71 – 9.83; 4thquartile HR 5.78, CI 2.10 – 15.9) and generally for anuria (quartiles with HR 5.72 – 7.21). The escalating risk of mortality and anuria was greater for those with diabetes mellitus. In conclusion, rapid decline in RRF over a 12-month period increased the risk of mortality and likewise anuria, beyond previously established risk factors for mortality and anuria. The impact on mortality and RRF preservation was particularly severe for those with diabetes mellitus.

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