Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose

Vilar, E.; Wellsted, David; Chandna, Shahid M.; Greenwood, Roger; Farrington, Ken

doi:10.1093/ndt/gfp071

Cited by 144 publications

(180 citation statements)

References 38 publications

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“…A relation between decline of RRF and more severe anemia and increased ESA resistance has been recognized previously in PD patients (1,10), but data in HD patients have been limited. Recently, it was shown that the mean ESA resistance index over time was 10% to 30% lower in patients with residual urea clearance Ն1 ml/min as compared with patients with residual urea clearance Ͻ1 ml/min (15). In the latter study, C-reactive protein levels were not statistically different between the low and high RRF groups.…”

Section: Discussionmentioning

confidence: 74%

“…This may translate to better volume control, less necessity for stringent fluid and salt restriction, and generally fewer intradialytic symptoms in patients with RRF. In view of the potential important role of RRF on multiple biochemical and clinical outcomes, controlling for RRF in observational studies should be considered (15), even if the GFR is very low.…”

Section: Discussionmentioning

confidence: 99%

“…In a cohort consisting of HD and PD patients, a relation between phosphate levels and RRF was found, but phosphate-binding agents were not accounted for in that study (19). Furthermore, erythropoiesis-stimulating agent (ESA) requirements were lower in HD patients with RRF in a single-center retrospective study, possibly because of decreased ESA resistance, but these observations were not adjusted for potential confounders (15). In a recent study, erythropoietin dose requirements were significantly lower in patients with urinary output 1 year after initiation of HD as compared with those without (16).…”

Section: Introductionmentioning

confidence: 91%

“…In terms of clinical outcomes, the degree of RRF has been inversely associated with left ventricular hypertrophy, independent of blood pressure or anemia level (10). Moreover RRF has been associated with improved survival in hemodialysis (HD) and peritoneal dialysis (PD) patients (11)(12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients.Design, setting, participants, & measurements Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output Ն100 ml/24 h (n ϭ 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output Ͻ100 ml/24 h, n ϭ 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models.Results Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR Ͼ 4.13 ml/min per 1.73 m 2 ), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 Ϯ 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. ConclusionsThis study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…19 RRF not only improves the nutritional status and quality of life, but also reduces the mortality in patients with chronic dialysis. 20 RRF is evaluated by the mean of creatinine and urea clearance rate and corrected with the body surface area. Detection of creatinine and urea clearance is a heavy burden for chronic dialysis patients because it requires collection of urine for 24 h. Therefore, some studies used the dialysis between 24 h urine to evaluate RRF.…”

Section: Discussionmentioning

confidence: 99%

Effects of Residual Renal Function on Left Ventricle and Analysis of Related Factors in Patients with Hemodialysis

Ding

2012

Renal Failure

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Background: Left ventricular hypertrophy (LVH) and systolic dysfunction would predict the mortality of patients undergoing maintenance hemodialysis. The cause of LVH is usually related to the increase of total peripheral vascular resistance and overloading volume. The presence of residual diuresis enables greater control of the volume. This study evaluated the effects of residual renal function (RRF) on the left ventricle and analyzed the related factors involved in hemodialysis patients. Methods: A total of 59 hemodialysis patients were classified into two groups. The patients in the RRF (RRFþ) group had a urine volume greater than 200 mL/24 h, and the patients in the non-RRF (RRFÀ) group had a urine volume less than 200 mL/24 h. B-type natriuretic peptide (BNP), blood total homocysteine (tHcy), and blood biochemical indexes were determined for the patients in both groups. Echocardiography and Doppler tests were performed to determine the cardiac indexes. Results: LVH and systolic dysfunction in the RRFþ group were less severe than those in the RRFÀ group. The concentration of tHcy and BNP in patients with RRF was decreased in comparison with those without RRF. The concentration of tHcy and BNP was positively correlated with the residual diuresis. Conclusions: There were distinct ventricular geometric patterns and different functional performances between RRFþ and RRFÀ groups. The presence of residual diuresis had a beneficial effect on the left ventricular function in hemodialysis patients.

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Incremental versus standard dialysis for people with kidney failure

Sabanayagam

Hegerty

et al. 2023

Cochrane Database of Systematic Reviews

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Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose

Abstract: The associations demonstrated suggest that residual renal function contributes significantly to outcome in HD patients and that efforts to preserve it are warranted. Comparative outcome studies should be controlled for residual renal function.

Cited by 144 publications

References 38 publications

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Effects of Residual Renal Function on Left Ventricle and Analysis of Related Factors in Patients with Hemodialysis

Incremental versus standard dialysis for people with kidney failure

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