Presence of Peripheral Arterial Disease Predicts Loss of Residual Renal Function in Incident CAPD Patients

Abstract

♦ Background: Accelerated cardiovascular disease (CVD), including peripheral arterial disease (PAD), is very common in patients with end-stage renal disease. Residual renal function (RRF) is a strong predictor of patient survival that is suggested to be linked to the degree of CVD. However, the relationship between PAD and decline in RRF has not previously been measured. ♦ Methods: We studied incident continuous ambulatory peritoneal dialysis patients from Peking University Third Hospital. An ankle brachial index of less than 0.9 was used to diagnose PAD. Residual renal function (RRF) was determined as the mean of 24-hour urea and creatinine clearances (glomerular filtration rate). The Cox proportional hazards model was used to identify factors predicting loss of RRF. ♦ Results: The study included 86 patients (age: 61 ± 14 years; men: 51%), 23 of whom had PAD at baseline. Mean follow-up was 19 months (median: 18 months; range: 6 -30 months). In univariate analysis, baseline PAD, peritonitis during follow-up, inflammation (C-reactive protein), serum uric acid, Ca×P, and serum phosphate were all significantly associated with a greater-than-50% decrease in RRF during follow-up. In multivariate analysis, only baseline PAD, Ca×P, and peritonitis were independently associated with a decline in RRF. ♦ Conclusions: Our study suggests that PAD may be a clinically important marker of CVD predicting the loss of RRF. It remains to be determined whether interventions aimed at decreasing PAD may also improve renal vascular status and thus slow the rate of RRF decline.

End-Stage Renal Disease versus Death in a Portuguese Cohort of Elderly Patients: An Approach using Competing Event Analysis

“…A reduced ankle–brachial index reflects peripheral arterial disease, and some studies demonstrated that this atherosclerotic disease marker predicted accelerated renal function decline, in general population,42 and also in peritoneal dialysis patients 43…”

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

“…Since data in table 3 suggested that the patients treated with fewer initial HD frequency had less incidence of RKF loss than patients treated with regular thrice-weekly HD, a Receiver Operating Characteristic (ROC) analysis was performed to decide the cut-off value of a 50% decline rate of GFR in a year for predicting whether the patient has lost RKF or not, as previously reported [35,36]. We found the best cut-off value was 0.044 (4.4%) with a specificity of 75% and a sensitivity of 64% (AUC = 0.65, p < 0.05) (see online suppl.…”

Proteinuria as a Risk Factor for Decline in Residual Renal Function in Non-Diabetic Peritoneal Dialysis Patients

“…This is a hypothetical cutoff for RRF decline. Some studies have used this as a criterion to indicate a significant decline in RRF [16,17]. Anuria was defined as <100 mL/day of urine volume.…”

“…The weekly Kt/V urea was calculated on the basis of 24-h urine and dialysate as follows: weekly Kt/V urea = 7 × {[24-h urine urea nitrogen content (mg/dL) × 24-h urine volume (L)] + [24-h dialysate urea nitrogen content (mg/dL) × 24-h drain volume (L)]}/[distribution volume of urea (L) × serum urea nitrogen (mg/dL)] [15]. The distribution volume of urea was calculated with V , estimated from a previous study [16]. Inadequate dialysis was defined as a weekly Kt/V urea value of < 1.7 in the K/DOQI guideline [5].…”