scholarly journals The evaluation of residual kidney function in patients with ckd vd and approaches of its preservation

2018 ◽  
pp. 41-48
Author(s):  
L. Surzhko
Keyword(s):  
Kidney Function ◽  
Residual Renal Function ◽  
Objective Data ◽  
Dialysis Patients ◽  
Dialysis Dose ◽  
Residual Kidney Function ◽  
Wide Range ◽  
Incremental Hemodialysis ◽  
The Relationship

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.

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 ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Function ◽  
Mortality Risk ◽  
Dialysis Patients ◽  
Residual Kidney Function ◽  
Incremental Hemodialysis

scholarly journals Rationale and Strategies for Preserving Residual Kidney Function in Dialysis Patients

2019 ◽  
Vol 50 (6) ◽  
pp. 411-421 ◽  
Author(s):  
Tian Li ◽  
Christopher S. Wilcox ◽  
Michael S. Lipkowitz ◽  
Judit Gordon-Cappitelli ◽  
Serban Dragoi
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Kidney Function ◽  
Urine Volume ◽  
Volume Control ◽  
Dialysis Patients ◽  
Patient Centeredness ◽  
Residual Kidney Function ◽  
Middle Molecules

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.

Preserving Residual Kidney Function

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.

Urea is the Best Molecule to Target Adequacy of Peritoneal Dialysis

2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 58-64 ◽  
Author(s):  
Frank A. Gotch
Keyword(s):  
Peritoneal Dialysis ◽  
Body Surface ◽  
Residual Renal Function ◽  
Dialysis Dose ◽  
Surface Areas ◽  
Wide Range ◽  
Anephric Patients ◽  
Dialysis Outcomes ◽  
Two Parameters ◽  
Urea Distribution Volume

For hemodialysis, a large base of data shows the validity of modelling the dialysis dose and reliably estimating protein intake from equilibrated Kt/V urea (eKt/VU), the total dialyzer urea clearance provided during each treatment divided by the urea distribution volume. An eKt/VU of 1.05 thrice weekly is judged adequate, but is still under study. In continuous ambulatory peritoneal dialysis (CAPD), two dosage criteria are widely recognized: continuous (“standard”) Kt/VU (stdKt/VU = 2.0 weekly), and total creatinine (Cr) clearance normalized to body surface area (KCrT = 70 L/week/1.73 m2). The CANUSA study concluded that a stdKt/VU of 2.1 and a KCrT of 70 L/week/1.73 m2 gave equivalent clinical outcomes. The Dialysis Outcomes Quality Initiative (DOQI) recommends values of 2.0 and 60 L/ week/1.73 m2 respectively. An analysis of these two parameters for males and females over a wide range of body surface areas (BSAs) was done and the analysis showed: ( 1 ) The U and Cr dose criteria are incommensurable—that is, they can virtually never be achieved simultaneously in anephric patients. ( 2 ) The Cr criterion varies widely with the sex of the patient and with the BSA-dependent variation in stdKt/VU over a range of 2.1 to 3.0. ( 3 ) The U criterion always produces a KCrT < 60 L/week/1.73 m2 in females and 60 – 70 L/ week/1.73 m2 in males. With respect to U and Cr, the CANUSA results were concluded to be valid in patients with substantial residual renal function, but probably not applicable to anephric patients where the doses are clearly incommensurable.

scholarly journals Development and Validation of Residual Kidney Function Estimating Equations in Dialysis Patients

2019 ◽  
Vol 1 (3) ◽  
pp. 104-114 ◽  
Author(s):  
Dominik Steubl ◽  
Li Fan ◽  
Wieneke M. Michels ◽  
Lesley A. Inker ◽  
Hocine Tighiouart ◽  
...  
Keyword(s):  
Kidney Function ◽  
Estimating Equations ◽  
Dialysis Patients ◽  
Residual Kidney Function ◽  
Development And Validation

scholarly journals The Relationship between Language, Literature, Teacher Effectiveness and Quality Education

2013 ◽  
Vol 2 (1) ◽  
pp. 29 ◽  
Author(s):  
Amase Lanior Emmanuel ◽  
Tsavmbu Aondover Alexis ◽  
Kaan Aondover Theophilus
Keyword(s):  
Teacher Effectiveness ◽  
Language Education ◽  
Quality Education ◽  
Quality Of Education ◽  
Effective Teacher ◽  
Wide Range ◽  
Language And Literature ◽  
The Relationship ◽  
Language Literature

The issue of declining quality of education in Nigeria is of serious national concern and quality language education is not an exception. A wide range of factors have been pointed out by experts as being responsible for this situation. Our purpose in this paper is to discuss possible ways of improving on the quality of language education being that the quality of an educational system cannot transcend that of the teachers. The paper contends that for quality language education to be provided, the teacher must be effective; he must be well grounded in both language and literature to effectively impart quality language education. The paper examines the interwoven relationship between language and literature and postulates that merely having many years of classroom experience does not automatically make one an effective teacher. It also discusses several other methods that could be adopted in teaching so as to improve on the quality of language education being provided. The paper concludes that the delicate relationship between language, literature and effective teaching must be sufficiently appreciated by the language teacher in order for the objectives of language course to be attained.

scholarly journals Impact of residual kidney function on hemodialysis adequacy and patient survival

2018 ◽  
Vol 33 (10) ◽  
pp. 1823-1831 ◽  
Author(s):  
Mengjing Wang ◽  
Yoshitsugu Obi ◽  
Elani Streja ◽  
Connie M Rhee ◽  
Jing Chen ◽  
...  
Keyword(s):  
Kidney Function ◽  
Proportional Hazards ◽  
Cox Model ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Dialysis Dose ◽  
Residual Kidney Function ◽  
Hazard Ratios ◽  
Laboratory Variables

ABSTRACTBackgroundBoth dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF.MethodsAmong 32 251 incident hemodialysis patients in a large US dialysis organization (2007–11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model.ResultsThe median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74–4.85] mL/min/1.73 m2 and 1.32 ± 0.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5–2.2 years) with an incidence of 15.4 deaths per 100 patient-years. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction = 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e. <3  mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (≥1.2) spKt/V were 1.40 (1.12–1.74), 1.21 (1.10–1.33), 1.06 (0.98–1.14), and 1.00 (0.93–1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively.ConclusionsIncident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.

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