A Fast Decline of Residual Renal Function in the First Year is a Predictor for Early Withdrawal from Peritoneal Dialysis in Non-Diabetic Patients

Abstract

Background/Aims: Little is known about the relationship between residual renal function (RRF) decline in early period and survival in non-diabetic peritoneal dialysis (PD) patients. Methods: A total of 567 non-diabetic patients who began PD from January 1, 2005 to June 30, 2013 was investigated. The rate of RRF decline was determined by the “slope of the trend equation” of serial RRFs. A composite end-point of all-cause mortality and conversion to hemodialysis (HD) was used, survival status was censored on June 30, 2016. Results: The median of “the slope of RRF decline equation” was 0.308 (0.001-2.111) ml/min/1.73 m2/ month. In the median follow-up period of 43 months (range 12 to 120 months), 65 (11.5%) patients died, 90 (15.9%) patients converted to HD and 171 (30.2%) patients received kidney transplantation. Multivariate linear regression showed male, high baseline RRF, high baseline peritoneal Kt/V urea, low serum albumin and low uric acid were independently associated with the rate of RRF decline in the first year of PD. Multivariate Cox models revealed that RRF decline in the first year remained a predictor for composite end-point (HR, 2.74, 95% CI, 1.53 to 4.90, P=0.001). The patients were divided into high RRF decline group (> 0.308ml/ min/1.73m2/month) and low RRF decline group (≤0.308 ml/min/1.73m2/month). In the first three years of PD, the rate of end-point events was higher in high RRF decline group (23.2%) than that in low RRF decline group (11.0%) (P< 0.001). There were 189 patients in low RRF decline group and 171 patients in high RRF decline group maintaining PD for more than 3 years, in a median follow-up of 54 months (range 37 to 120 months), the survival rate was 30.9% in high RRF decline group and 46.4% in low RRF decline group (P=0.883). In high RRF decline group, there were 92 patients reaching composited end-point and 112 patients maintaining PD; multivariate Cox model showed high peritoneal Kt/V urea after 1 year of PD and high albumin level were protective factors (HR, 0.29, 95% CI, 0.13 to 0.61, P= 0.001; HR, 0.94, 95% CI, 0.90-0.99, P=0.022, respectively), while fast RRF decline remained risk factor for composite end-point (HR, 3.28, 95% CI,1.48-7.31, P=0.004). Conclusion: A faster RRF decline in the first year was a predictor for all-cause mortality and conversion to HD in non-diabetic PD patients, mainly in the first three year. For patients with faster RRF decline, increasing PD dose was effective to improve survival.

Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients

“…Wang et al. [ 24 ] found that RRF decline in the first year of PD was an independent predictor of prognosis during the first 3 years of PD therapy, while after more than 3 years, RRF decline no longer correlated with clinical outcomes. Another notable point is that patients were younger in the dialysis inadequacy group.…”

The association between serum cystatin C and residual renal function in peritoneal dialysis patients

“…As RRF decreases, PD is usually increased to compensate for inadequate dialysis [11]. Linear regression analysis was used to further understand the impact of cystatin C removal by RRF and PD on serum cystatin C levels.…”

“…Only RRF could serve as an independent predictor of prognosis [8,9], and strong RRF was an important guarantee for PD patients to maintain adequate dialysis [10]. The rapid decline of RRF in the first year is an independent risk factor for PD patient death and withdrawal [11]. Thus, the RRF of PD patients should be regularly monitored to characterize factors that contribute to the rapid decline of RRF and take timely intervention measures to protect RRF.…”

Correlations between gender, age and the risk of withdrawal from peritoneal dialysis

“…In our study, the multivariate Cox proportional hazards model showed that the level of serum albumin was a relevant risk factor for CAPD patients to withdraw from treatment. Chen HL [15] , Griva K [18] , Wang J [19] ,et al found that lower serum albumin levels were associated with an increased risk of technical failure in analysis of risk factors related to PD patients. The results of our analysis showed that the withdrawal risk of patients with serum albumin above 35 g/L was 43.7% lower than that of patients below 35 g/L.…”