Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients

Background: High ultrafiltration rate (UFR) has been associated with increased mortality in hemodialysis (HD) patients. However, the impact of UFR on decline of residual kidney function (RKF) has not been elucidated among patients receiving conventional HD. Methods: We performed a retrospective cohort study of 7,753 patients who initiated conventional HD from 2007 to 2011 and survived the first year of dialysis with baseline UFR and renal urea clearance (KRU) data at baseline and 1 year (5th patient-quarter). The primary exposure was average UFR at the 1st patient-quarter from dialysis initiation (<4, 4 to <6, 6 to <9, 9 to <13, and ≥13 mL/h/kg). Decline in RKF was defined as the percent change in KRU and decline in urine output during the first year after initiation of dialysis. We used a logistic regression model for rapid decline in RKF and a linear regression model for change in urine volume. Results: In our HD cohort, mean baseline UFR was 7.0 ± 3.1 mL/h/kg, and median (interquartile range) baseline KRU was 3.5 (2.1–5.3) mL/min/1.73 m2. There was a graded association between UFR and a rapid decline in RKF; the expanded case mix-adjusted ORs and 95% CIs were 1.21 (1.04–1.40), 1.34 (1.16–1.55), 1.73 (1.46–2.04), and 1.93 (1.48–2.52) for baseline UFR 4 to <6, 6 to <9, 9 to <13, and ≥13 mL/h/kg, respectively (reference: <4 mL/h/kg). KRU trajectories showed a greater KRU decline over time in higher UFR categories. Higher UFR was also associated with a greater decline in urine output after 1 year. Conclusion: Higher UFR was associated with a rapid decline in RKF among conventional HD patients. Further clinical trials are needed to elucidate a causal effect of UFR on RKF among HD patients.

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Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population

Toxins ◽

10.3390/toxins11040235 ◽

2019 ◽

Vol 11 (4) ◽

pp. 235 ◽

Cited By ~ 5

Author(s):

Evelien Snauwaert ◽

Els Holvoet ◽

Wim Van Biesen ◽

Ann Raes ◽

Griet Glorieux ◽

...

Keyword(s):

Kidney Function ◽

Urine Volume ◽

Correlation Coefficients ◽

Analysis Of Covariance ◽

Uremic Toxin ◽

Multisystem Disease ◽

Residual Kidney Function ◽

Pediatric Hemodialysis ◽

Ckd Stage ◽

The Impact

Protein-bound uremic toxins (PBUTs) play a role in the multisystem disease that children on hemodialysis (HD) are facing, but little is known about their levels and protein binding (%PB). In this study, we evaluated the levels and %PB of six PBUTs cross-sectionally in a large pediatric HD cohort (n = 170) by comparing these with healthy and non-dialysis chronic kidney disease (CKD) stage 4–5 (n = 24) children. In parallel β2-microglobulin (β2M) and uric acid (UA) were evaluated. We then explored the impact of age and residual kidney function on uremic toxin levels and %PB using analysis of covariance and Spearman correlation coefficients (rs). We found higher levels of β2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) in the HD compared to the CKD4–5 group. In the HD group, a positive correlation between age and pCG, HA, IxS, and pCS levels was shown. Residual urine volume was negatively correlated with levels of β2M, pCG, HA, IAA, IxS, and CMPF (rs −0.2 to −0.5). In addition, we found overall lower %PB of PBUTs in HD versus the CKD4–5 group, and showed an age-dependent increase in %PB of IAA, IxS, and pCS. Furhtermore, residual kidney function was overall positively correlated with %PB of PBUTs. In conclusion, residual kidney function and age contribute to PBUT levels and %PB in the pediatric HD population.

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Association of B-Type Natriuretic Peptide Level with Residual Kidney Function in Incident Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00241 ◽

2019 ◽

Vol 39 (2) ◽

pp. 147-154 ◽

Cited By ~ 1

Author(s):

Yasuhiro Kawai ◽

Shigeru Tanaka ◽

Hisako Yoshida ◽

Masatoshi Hara ◽

Hiroaki Tsujikawa ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Kidney Function ◽

Natriuretic Peptide ◽

Subgroup Analysis ◽

Proportional Hazards Model ◽

Urine Volume ◽

Cox Proportional Hazards Model ◽

University Hospital ◽

Residual Kidney Function ◽

Increased Risk

Background Residual kidney function (RKF) is an important factor influencing both technique and patient survival in peritoneal dialysis (PD) patients. B-type natriuretic peptide (BNP) is considered a marker of cardio-renal syndrome. The relationship between BNP and RKF in PD patients remains unclear. Methods We conducted a prospective study of 89 patients who had started and continued PD for 6 months or more in Kyushu University Hospital between June 2006 and September 2015. Participants were divided into low BNP (≤ 102.1 ng/L) and high BNP (> 102.1 ng/L) groups according to median plasma BNP level at PD initiation. The primary outcome was RKF loss, defined as 24-hour urine volume less than 100 mL. We estimated the association between BNP and RKF loss using a Kaplan-Meier method and Cox proportional hazards model and compared the rate of RKF decline between the 2 groups. To evaluate the consistency of the association, we performed subgroup analysis stratified by baseline characteristics. Results During the median follow-up of 30 months, 30 patients lost RKF. Participants in the high BNP group had a 5.87-fold increased risk for RKF loss compared with the low BNP group after adjustment for clinical and cardiac parameters. A high plasma BNP level was more clearly associated with RKF loss in younger participants compared with older participants in subgroup analysis. Conclusions B-type natriuretic peptide may be a useful risk marker for RKF loss in PD patients. The clinical importance of plasma BNP level as a marker of RKF loss might be affected by age.

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The impact of lower urinary tract symptomatology on urine volumes in stone formers

Canadian Urological Association Journal ◽

10.5489/cuaj.5530 ◽

2018 ◽

Vol 13 (8) ◽

Author(s):

Nathan Y. Hoy ◽

Nick S. Dean ◽

Jeremy Wu ◽

Timothy A. Wollin ◽

Shubha K. De

Keyword(s):

Urinary Tract ◽

Urine Output ◽

Lower Urinary Tract ◽

Urine Volume ◽

Urine Collection ◽

Inclusion Criteria ◽

Stone Formers ◽

Number Of Patients ◽

The Impact ◽

Lower Urinary

Introduction: We aimed to determine if there is a correlation between International Prostate Symptom scores (IPSS) and 24-hour urine collection volumes, as patients experiencing lower urinary tract symptoms (LUTS) may have impaired ability to increase fluid intake for stone prevention.Methods: We conducted a single-centre, retrospective review was performed of stone-formers presenting from 2014‒2016. Inclusion criteria were completion of an IPSS questionnaire and a 24-hour urine collection. Exclusion criteria included symptomatic stone or urinary tract infection at time of IPSS completion, inadequate 24-hour collection, or incomplete IPSS questionnaire.Results: A total of 131 patients met inclusion criteria. Stratification by IPSS severity into mild (0‒7), moderate (8‒19), and severe (20‒35) yielded groups of n=96, 28, and 7, respectively. Linear regression modelling did not reveal a correlation between IPSS score and volume (p=0.10). When compared to those with adequate urine volumes (>2 L/day, n=65), low-volume patients (<1 L/day, n=10) had a significantly higher total IPSS (11.7 vs. 6.1; p=0.036). These groups showed significant differences in their responses to questions about incomplete emptying (p=0.031), intermittency (p=0.011), and stranguria (p=0.0020), with higher scores noted in the low urine output group.Conclusions: This study is the first to examine the correlation between IPSS and 24-hour urine volume. Though our data does not show a linear relationship between urine output and IPSS, those with lower urine volumes appear to have worse self-reported voiding symptoms when compared to those with adequate volumes (>2 L/day) for stone prevention. The overall number of patients in our study is relatively small, which may account for the lack of a relationship between IPSS and 24-hour urine volumes.

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High rates of protein intake are associated with an accelerated rate of decline of residual kidney function in incident peritoneal dialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy393 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1394-1400 ◽

Cited By ~ 1

Author(s):

Pablo Otero Alonso ◽

Miguel Pérez Fontán ◽

Antía López Iglesias ◽

Teresa García Falcón ◽

Ana Rodríguez-Carmona

Keyword(s):

Peritoneal Dialysis ◽

Kidney Function ◽

Odds Ratio ◽

Protein Intake ◽

First Year ◽

Main Study ◽

Study Variable ◽

Residual Kidney Function ◽

Rate Of Decline

AbstractBackgroundPreservation of residual kidney function (RKF) is a relevant objective in peritoneal dialysis (PD) patients. The influence of dietary protein intake (PI) on this variable has not been adequately investigated.MethodsFollowing an observational design, we studied 336 patients incident on PD, with a minimum follow-up of 6 months. The main study variable was the mean PI [normalized rate of protein nitrogen appearance (nPNA)] during the first 4 months on PD. The main outcome variables were the absolute rate of decline of RKF and the proportion of patients presenting a >50% decay of their RKF during the first year of follow-up. We applied univariate and multivariate strategies of analysis, taking into consideration the main control variables bearing a correlation with nPNA and/or RKF.ResultsMean nPNA (first 4 months) was 1.23 ± 0.33 g/kg/day, while the overall rate of decline of RKF was −0.13 ± 0.29 mL/min/month; 69 patients (25.1%) had lost >50% of their initial RKF by the end of the first year. Univariate analysis disclosed consistent associations between the main study variable on one hand and baseline RKF (r = 0.32, P < 0.0005) and its rate of decline (r = −0.23, P < 0.0005) on the other. The latter two variables were also significantly correlated (r = −0.36, P < 0.0005). Multivariate analysis identified mean nPNA as an independent predictor of the rate of decline of RKF [odds ratio 1.09 per 0.10 g/kg/day, 95% confidence interval (CI) 0.99–1.19, P = 0.058] and, in particular, of the probability of losing >50% of the baseline RKF during the first year of treatment (odds ratio 1.15 per 0.10 g/kg/day, 95% CI 1.04–1.27, P = 0.006).ConclusionHigher rates of PI during the first months of therapy are associated with a faster decline of RKF among patients incident on PD. Our results underline the convenience of keeping an adequate balance between sufficient protein ingestion, to prevent malnutrition and wasting, and sensible restriction in stable, adequately nourished individuals with rates of intake in the higher range or above-recommended allowances.

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A multicenter feasibility randomized controlled trial to assess the impact of incremental versus conventional initiation of hemodialysis on residual kidney function

Kidney International ◽

10.1016/j.kint.2021.07.025 ◽

2021 ◽

Author(s):

Enric Vilar ◽

Raja M. Kaja Kamal ◽

James Fotheringham ◽

Amanda Busby ◽

Jocelyn Berdeprado ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Kidney Function ◽

Controlled Trial ◽

Randomized Controlled ◽

Residual Kidney Function ◽

The Impact

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Effectiveness of Renin-Angiotensin-Aldosterone System Blockade on Residual Kidney Function and Peritoneal Membrane Function in Peritoneal Dialysis Patients: A Network Meta-Analysis

Scientific Reports ◽

10.1038/s41598-019-55561-5 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Sirayut Phatthanasobhon ◽

Surapon Nochaiwong ◽

Kednapa Thavorn ◽

Kajohnsak Noppakun ◽

Setthapon Panyathong ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Kidney Function ◽

Active Control ◽

Meta Analysis ◽

Urine Volume ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Membrane Function ◽

Raas Blockade ◽

Residual Kidney Function

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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P1441SURVIVAL AND RESIDUAL KIDNEY FUNCTION IN HEMODIALYSIS PATIENTS TREATED WITH HIGH DOSES OF FUROSEMIDE. A PROSPECTIVE LONG TERM STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1441 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Esteban Siga ◽

Romina Alcuaz ◽

Eduardo Nozzi ◽

Eugenia Melon Gil ◽

Nora Vivas ◽

...

Keyword(s):

Informed Consent ◽

Kidney Function ◽

First Year ◽

Term Study ◽

Cutaneous Manifestations ◽

Long Term Study ◽

Residual Kidney Function ◽

Patient Reported ◽

High Doses

Abstract Background and Aims Many patients (PTS) starting dialysis have significant residual kidney function (RKF), with 45 % having an estimated glomerular filtration rate ≥10 mL/min/1.73 m2 . Preservation of this residual kidney function has been associated with improved outcomes, and nephrologists should try to preserve this residual kidney function as long as possible. In this setting, furosemide (FURO) could play an important role but there are no guidelines for its use and, given the need of high doses, there are safety concerns which limit its use. Besides, its long term utility has not been established. In this study, our first aim was to determine an effective and safe dose for incident PTS; and the second was to evaluate its effects on the RKF in the first year and the survival of these PTS in the long term. Method Protocol I: cross-over, single blind study, consisting of three weekly periods. During the first week (W1), after signing an informed consent, PTS were randomly assigned to receive 250 (F250) or 500 (F500) mg.of oral FURO once a day. W2 was a washout period and patients received placebo (F0). During the third week, the remaining dose was prescribed. At the end of each W, total urinary volume and Natriuresis of 24 hours was measured. All Capsules were identical, made by the Hospital´s Pharmacist, and PTS were not aware of their content. Protocol II: prospective, open label, long term study. Daily diuresis was measured In all Incident PTS from 01/01/11 to 01/06/19. Those PTS with daily diuresis lower than 200 ml. were the control sample. Those with higher than 200 ml.day, after signing an informed consent, received 500 mg. of oral FURO once a day. At the beginning and the end of the FURO period, 24 hours diuresis was colected to measure volume and Na, K y P. In some PTS, Beta 2 seric microglobulin (B2M) was also measured. All PTS ( n = 101 ) were followed until their obitus, or were censored by transplant, change of centre or completion of the follow up period = 4 years. Results Protocol I: n= 34. Basal diuresis (F0) was 970 ml.day. Effect of F250 and F500 on diuresis was similar. Both increased 24 hs urinary volumen by 30%. By contrast, the increase of Sodium excretion was significantly higher with F500 than with F250: 56 vs 7%, P =0.000 Protocol II: The table shows the long term effect (11.8 +/- 4.7 months) of 500 mg. once a day of oral FURO in 33 incident PTS (8 DBT, 8 women). Data are presented as median and interquartil range (IR). In the first year of HD, FURO was able to maintain the basal diuresis and the median excretion of P. Noteworthy, Natriuresis increased by 29%. Seric B2M was asociated with diuresis: r = -0.59, and was significantly lower than B2M measured in control PTS: 36.7 vs. 48.1 mg.dl (P = 0.011). FURO and Control PTS were followed up to four years. Kaplan Meier analisis ( Figure ) ilustrated that survival in FURO PTS was 96, 90,5 and 73,5 % at 2, 3 and 4 years, respectively, whereas In control PTS it was 76, 65 and 53 %. (P = 0.042, logrank test ). Four PTS stopped FURO ingestion before six months and were excluded. One due to cramps and three by cutaneous manifestations. All symptoms remitted when Furosemide was suspended. No patient reported hearing impairments Conclusion Results of this long term prospective study suggest that Furosemide is effective to maintain RKF in the first year of HD, without major adverse effects. Furthermore, survival was significantly higher in those PTS that ingested Furosemide

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Association of genetic variants for plasma LRG1 with rapid decline in kidney function in patients with type 2 diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab268 ◽

2021 ◽

Author(s):

Resham Lal Gurung ◽

Rajkumar Dorajoo ◽

M Yiamunaa ◽

Jian-Jun Liu ◽

Sharon Li Ting Pek ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glomerular Filtration ◽

Kidney Function ◽

Genetic Variants ◽

Genome Wide Association Study ◽

Causal Effect ◽

Mendelian Randomisation ◽

Rapid Decline ◽

A Genome

Abstract Context Elevated levels of plasma Leucine Rich α-2-Glycoprotein 1 (LRG1), a component of TGF-ß signalling, are associated with development and progression of chronic kidney disease in patients with type 2 diabetes (T2D). However, whether this relationship is causal is uncertain. Objectives To identify genetic variants associated with plasma LRG1 levels and determine whether genetically predicted plasma LRG1 contributes to a rapid decline in kidney function (RDKF) in patients with T2D. Design and participants We performed a genome-wide association study (GWAS) of plasma LRG1 among 3,694 T2D individuals [1,881(983 Chinese, 420 Malay and 478 Indian) discovery from SMART2D cohort and 1,813 (Chinese) validation from DN cohort]. One- sample Mendelian randomization analysis was performed among 1,337 T2D Chinese participants with preserved glomerular filtration function (baseline estimated glomerular filtration rate (eGFR) >60ml/min/1.73m 2). RDKF was defined as an eGFR decline of 3 mL/min/1.73 m 2/year or greater. Results We identified rs4806985 variant near LRG1 locus robustly associated with plasma LRG1 levels (MetaP=6.66x10 -16). Among 1,337 participants, 344 (26%) developed RDKF and the rs4806985 variant was associated with higher odds of RDKF (meta odds ratio =1.23, P=0.030 adjusted for age and sex). Mendelian randomisation analysis provided evidence for a potential causal effect of plasma LRG1 on kidney function decline in T2D (P<0.05). Conclusion We demonstrate that genetically influenced plasma LRG1 increases the risk of RDKF in T2D patients suggesting plasma LRG1 as a potential treatment target. However, further studies are warranted to elucidate underlying pathways to provide insight into DKD prevention.

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