An endoAVF can be reliably created using a radiofrequency magnetic catheter-based system, without open surgery and with minimal complications. The endoAVF can be successfully used for hemodialysis and demonstrated high 12-month cumulative patencies. It may be a viable alternative option for achieving AVFs for hemodialysis patients in need of vascular access.

♦ Objective The aim of this study was to prospectively evaluate the risk factors for decline of residual renal function (RRF) in an incident peritoneal dialysis (PD) population. ♦ Design Prospective observational study of an incident PD cohort at a single center. ♦ Setting Tertiary-care institutional dialysis center. ♦ Participants The study included 146 consecutive patients commencing PD at the Princess Alexandra Hospital between 1 August 1995 and 1 July 2001 (mean age 54.8 ± 1.4 years, 42% male, 34% diabetic). Patients with failed renal transplants ( n = 26) were excluded. ♦ Main Measurements Timed urine collections ( n = 642) were performed initially and at 6-month intervals thereafter to measure RRF. The development of anuria was also prospectively recorded. ♦ Results The mean (±SD) follow-up period was 20.5 ± 14.8 months. The median slope of RRF decline was –0.05 mL/minute/month/1.73 m2. Using binary logistic regression, it was shown that the 50% of patients with more rapid RRF loss (< –0.05 mL/min/month/1.73 m2) were more likely to have had a higher initial RRF at commencement of PD [adjusted odds ratio (AOR) 1.83, 95% confidence interval (CI) 1.39 – 2.40] and a higher baseline dialysate/plasma creatinine ratio at 4 hours (D/P creat; AOR 44.6, 95% CI 1.05 – 1900). On multivariate Cox proportional hazards model analysis, time from commencement of PD to development of anuria was independently predicted by baseline RRF [adjusted hazard ratio (HR) 0.81, 95% CI 0.60 – 0.81], D/P creat (HR 2.87, 95% CI 2.06 – 82.3), body surface area (HR 6.23, 95% CI 1.53 – 25.5), dietary protein intake (HR 2.87, 95% CI 1.06 – 7.78), and diabetes mellitus (HR 1.65, 95% CI 1.00 – 2.72). Decline of RRF was independent of age, gender, dialysis modality, urgency of initiation of dialysis, smoking, vascular disease, blood pressure, medications (including angiotensin-converting enzyme inhibitors), duration of follow-up, and peritonitis rate. ♦ Conclusions The results of this study suggest that high baseline RRF and high D/P creat ratio are risk factors for rapid loss of RRF. Moreover, a shorter time to the onset of anuria is independently predicted by low baseline RRF, increased body surface area, high dietary protein intake, and diabetes mellitus. Such at-risk patients should be closely monitored for early signs of inadequate dialysis.

Analysis 1.1. Comparison 1 Net change with altering salt and change by duration, Outcome 1 Sodium excretion. . Analysis 1.2. Comparison 1 Net change with altering salt and change by duration, Outcome 2 Systolic blood pressure. Analysis 1.3. Comparison 1 Net change with altering salt and change by duration, Outcome 3 Diastolic blood pressure. Analysis 1.4. Comparison 1 Net change with altering salt and change by duration, Outcome 4 eGFR [mL/min/1.73 m2]. Analysis 1.5. Comparison 1 Net change with altering salt and change by duration, Outcome 5 Creatinine clearance. Analysis 1.6. Comparison 1 Net change with altering salt and change by duration, Outcome 6 Log creatinine clearance. Analysis 1.7. Comparison 1 Net change with altering salt and change by duration, Outcome 7 Serum creatinine. . . Analysis 1.8. Comparison 1 Net change with altering salt and change by duration, Outcome 8 Effective renal plasma flow. Analysis 1.9. Comparison 1 Net change with altering salt and change by duration, Outcome 9 Filtration fraction (%). Analysis 1.10. Comparison 1 Net change with altering salt and change by duration, Outcome 10 Weight. . . . . Analysis 1.11. Comparison 1 Net change with altering salt and change by duration, Outcome

Metabolic syndrome occurs in 30.5% of stages 4 and 5 CKD patients and is associated with older age, peritoneal dialysis, ethnicity, increased oxidative stress, lower serum adiponectin concentrations and a significantly increased risk of future cardiovascular events. Intervention strategies targeting hypercholesterolaemia, hyperhomocysteinaemia, anaemia and disordered bone mineral metabolism may not be effective in ameliorating the heightened cardiovascular risk of CKD patients with MS.