Preserving Residual Renal Function in Dialysis: What We Know

Patel, Nirmal; Hu, Susie L.

doi:10.1111/sdi.12302

Cited by 18 publications

(12 citation statements)

References 87 publications

(114 reference statements)

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“…The rate of decline of RKF is more rapid in HD than in peritoneal dialysis patients. 10 , 25 Nonetheless, substantial RKF may last for years in HD patients, 26 , 27 and our own longitudinal urine collections support this. The frequency of HD may have an effect on the longevity of RKF.…”

Section: Discussionsupporting

confidence: 58%

Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function

Chin

Appasamy

Carey

et al. 2017

Kidney International Reports

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IntroductionWe hypothesized that at least half of incident hemodialysis (HD) patients on 3-times weekly dialysis could safely start on an incremental, 2-times weekly HD schedule if residual kidney function (RKF) had been considered.MethodsRKF is assessed in all our HD patients. This single-center, retrospective cohort study of incident adult HD patients, who survived ≥6 months on a 3-times weekly HD regimen and had a timed urine collection within 3 months of starting HD, assessed each patient’s theoretical ability to achieve adequate urea clearance, ultrafiltration rate, and hemodynamic stability if on 2-times weekly HD.ResultsOf the 410 patients in the cohort, we found that 112 (27%) could have optimally and 107 (26%) could have been appropriately considered for 2-times weekly incremental HD. In general, diuretics were underutilized in >50% of subjects who had adequate RKF urea clearance. The optimal 2-times weekly patients had better potassium and phosphorus control. The correlation coefficient of calculated residual kidney urea clearance with 24-hour urine volume and with kinetic model residual kidney clearance was 0.68 and 0.99, respectively.DiscussionMore than 50% of incident HD patients with RKF have adequate kidney urea clearance to be considered for 2-times weekly HD. When additionally ultrafiltration volume and blood pressure stability are taken into account, more than one-fourth of the total cohort could optimally start HD in an incremental fashion.

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Section: Discussionsupporting

confidence: 58%

Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function

Chin

Appasamy

Carey

et al. 2017

Kidney International Reports

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“…In HD, repeated exposure of blood to the dialysis membrane is harmful to RRF [54] . Many studies have shown that the biocompatible polysulfone dialysis membranes used in HD slow the decline in RRF [89,90] .…”

Section: Dialysis Techniquesmentioning

confidence: 99%

“…Cardiovascular diseases including renal artery stenosis and chronic heart failure, obesity, and hyperuricemia all are risk factors with regard to preservation of RRF [28,[54][55][56] .…”

Section: Original Renal Diseases and Comorbiditymentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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Background: Residual renal function (RRF), defined as the ability of native kidneys to eliminate water and uremic toxins, is closely correlated with mortality and morbidity rates among patients receiving either peritoneal dialysis (PD) or hemodialysis (HD) via continuous clearance of middle-sized molecules and protein-bound solutes. Therefore, preserving RRF is considered to be one of the primary goals in managing patients with end-stage renal disease (ESRD). Summary and Key Messages: In this article, we provide a review on the understanding and management of RRF in patients on dialysis. RRF may be estimated and measured by calculating the mean 24-hour urine creatinine level and urea clearance. Currently, several middle-sized molecules are reported but rarely used in practice. Many risk factors such as original renal diseases, dietary intake, and nephrotoxic agents impair RRF. Targeting such factors may halt the decline in RRF and offer better outcomes for patients on PD or HD. Except for in PD patients, RRF is a powerful predictor of survival in HD patients. RRF requires more clinical and research attention in the care of patients with ESRD on dialysis.

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“…Avoidance of nephrotoxic agents (eg, radiocontrast dye, aminoglycosides, NSAIDs) and IDH episodes is important to preserve RRF. Small studies have suggested that RRF can be maintained with ACE‐I and ARB therapy, but this remain to be proven . Recently, it has been suggested that incremental HD in incident patients better preserves RRF.…”

Section: Potential Harmsmentioning

confidence: 99%

“…Most dialysis patients inevitably lose RRF; for PD patients, this typically occurs within 2 years and more quickly in HD patients. RRF declined during the first year in 71% of 6538 incident HD patients in a DaVita database in whom such data were available …”

Section: Potential Harmsmentioning

confidence: 99%

Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management

Levin

Aşçı

et al. 2017

Seminars in Dialysis

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Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume. These include intradialytic hypotension; ischemia of heart, brain, and gut; loss of residual renal function; and vascular access thrombosis. Comprehensibly, physicians are hesitant to follow strict volume control policy because of these safety concerns. Current data, however, suggest that a high ultrafiltration rate rather than the reduction in excess volume is related to these complications. Restriction of dietary salt intake, increased frequency, and/or duration of hemodialysis sessions or addition of temporary extra sessions during the process of gradually reducing postdialysis body weight in conventional hemodialysis and discontinuation of antihypertensive medications may prevent these complications. We believe that even if an unwanted effect occurs while gradually reaching euvolemia, this is likely to be counterbalanced by favorable cardiovascular outcomes such as regression of left ventricular hypertrophy, prevention of heart failure, and, ultimately, cardiovascular mortality as a result of the eventual achievement of normal extracellular fluid volume and blood pressure over the long term.

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Preserving Residual Renal Function in Dialysis: What We Know

Cited by 18 publications

References 87 publications

Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function

Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management

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