Preservation of residual renal function by not removing water in new hemodialysis patients: a randomized, controlled study

Liu, Sha; Diao, Zongli; Zhang, Dongliang; Ding, Jiaxiang; Cui, Wenying; Liu, Wenhu

doi:10.1007/s11255-012-0346-2

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…However, a recent randomized, controlled trial found no significant difference in RKF decline over time with use of the angiotensin receptor blocker irbesartan versus placebo in patients undergoing hemodialysis. 25 Although the not removing water strategy with hemodialysis may maintain urine volume, it also increases BP, left ventricular mass index, and cardiovascular events, 26 suggesting the importance of individualized volume management to avoid both congestive heart failure and intradialytic hypotension. 9,27 Other potential strategies include avoidance of nephrotoxic agents, ultrapure dialysis fluid, 28 online hemodiafiltration, 29,30 diuretic use, 31,32 and incremental hemodialysis regimens.…”

Section: Discussionmentioning

confidence: 99%

Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients

Obi

Rhee

Mathew

et al. 2016

JASN

140

143

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In patients with ESRD, residual kidney function (RKF) contributes to achievement of adequate solute clearance. However, few studies have examined RKF in patients on hemodialysis. In a longitudinal cohort of 6538 patients who started maintenance hemodialysis over a 4-year period (January 2007 through December 2010) and had available renal urea clearance (CL) data at baseline and 1 year after hemodialysis initiation, we examined the association of annual change in renal CL rate with subsequent survival. The median (interquartile range) baseline value and mean±SD annual change of CL were 3.3 (1.9-5.0) and -1.1±2.8 ml/min per 1.73 m, respectively. Greater CL rate 1 year after hemodialysis initiation associated with better survival. Furthermore, we found a gradient association between loss of RKF and all-cause mortality: changes in CL rate of -6.0 and +3.0 ml/min per 1.73 m per year associated with case mix-adjusted hazard ratios (95% confidence intervals) of 2.00 (1.55 to 2.59) and 0. 61 (0.50 to 0.74), respectively (reference: -1.5 ml/min per 1.73 m per year). These associations remained robust against adjustment for laboratory variables and ultrafiltration rate and were consistent across strata of baseline CL, age, sex, race, diabetes status, presence of congestive heart failure, and hemoglobin, serum albumin, and serum phosphorus levels. Sensitivity analyses using urine volume as another index of RKF yielded consistent associations. In conclusion, RKF decline during the first year of dialysis has a graded association with all-cause mortality among incident hemodialysis patients. The clinical benefits of RKF preservation strategies on mortality should be determined.

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Section: Discussionmentioning

confidence: 99%

Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients

Obi

Rhee

Mathew

et al. 2016

JASN

140

143

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“…Strict volume control during HD may decrease rGFR and rUV . Large UF volumes and high UF rates are associated with an increased frequency of intradialytic hypotension , which is an independent predictor of RRF decline , possibly due to ischemia‐induced acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

Diuretics, Limited Ultrafiltration, and Residual Renal Function in Incident Hemodialysis Patients: A Case Series

Sjölund

Anton

Bayes

et al. 2016

Seminars in Dialysis

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The effect of diuretics on residual renal function expressed as residual GFR (rGFR) and urine volume (rUV) using 24-hour urine collections has not been well examined in hemodialysis (HD) patients. We present a small (seven patient) but provocative case series describing a strikingly low rate of decline in rUV and rGFR (average of creatinine and urea clearances, 24-hour urine collections) in patients treated with increasing doses of furosemide (up to 360 mg/day) during the first 2 years after initiation of HD. Between 6 and 12 months, the mean rUV fell by 1 ml/month, whereas rGFR declined by 0.03 ml/min/1.73 m(2) /month. The mean rate of decline from 12 to 24 months for rUV (33 ml/month) and rGFR (0.02 ml/min/1.73 m(2) /month) were also low. While data are clearly limited and the observation retrospective, they are consistent with the better documented benefit of diuretics observed in end-stage renal disease patients treated with peritoneal dialysis.

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“…A 56‐patient, controlled study of Chinese patients recently started on HD found that those having no fluid removal during treatment had greater preservation of creatinine clearance and urine volume (+164 vs. −726 ml/day), but with higher blood pressures at 6‐month follow‐up than those managed conventionally . However, maintenance of extracellular expansion as measured by bioimpedance did not preserve residual GFR in a retrospective study of a large cohort of PD patients.…”

Section: Inflammation and Comorbid Diseasesmentioning

confidence: 98%

Preserving Residual Renal Function in Dialysis: What We Know

Patel

2014

Seminars in Dialysis

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Residual renal function confers a survival benefit among dialysis patients thought to be related to greater volume removal and solute clearance. Whether the presence of residual renal function is protective or merely a marker for better health is not clear. The basic mechanisms governing the decline or persistence of residual renal function are poorly understood and few studies have examined the role of medical therapy in its preservation. Dialysis modality, inflammatory processes often associated with comorbid diseases (including diabetes mellitus and obesity), volume dysregulation, and vitamin D deficiency are predictive of residual renal function decline. We review potential mechanisms for preservation of remaining glomerular filtration rate among chronic dialysis patients.

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Preservation of residual renal function by not removing water in new hemodialysis patients: a randomized, controlled study

Abstract: Preservation of RRF by NWR is warranted in new HD patients, but is not appropriate for all patients.

Cited by 10 publications

References 15 publications

Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients

Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients

Diuretics, Limited Ultrafiltration, and Residual Renal Function in Incident Hemodialysis Patients: A Case Series

Preserving Residual Renal Function in Dialysis: What We Know

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