Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

Abstract

♦ BACKGROUND: The aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD). ♦ METHODS: The study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m]), etiology of ESRD, PD fluid volume (mL/m/24 h), glucose load (g/m/24 h), ultrafiltration (mL/m/24 h), peritoneal permeability (D/P, D/D), dialysis adequacy (twKt/V, twCCr [L/week/1.73 m]), blood pressure (BP), biochemical parameters, and medications used. Duration of follow-up was 24 months. ♦ RESULTS: Mean diuresis before initiation of PD was 1,394.93 ± 698.37 (mL/m/24 h), and mean rGFR was 7.41 ± 3.96 (mL/min/1.73 m). The rate of daily diuresis decline was -529.34 ± 546.28 in the first year and -107.10 ± 291.54 (mL/m/24 h) in the second year (p = 0.005), and the rate of rGFR decline was -3.35 ± 3.73 in the first year and -1.63 ± 1.85 (mL/min/1.73 m) in the second year (p = 0.118). Eleven (19.64%) patients became anuric. In univariate analysis, the rate of daily diuresis decline in the first year was related to baseline diuresis (r = -0.29, p = 0.031), proteinuria (r = -0.43, p = 0.001), and systolic BP (r = -0.31, p = 0.020); 12-month changes (Δ0 - 12) in PD fluid volume (r = -0.37, p = 0.004), glucose load (r = -0.28, p = 0.035), and ultrafiltration (r = -0.38, p = 0.004); serum calcium-phosphorus product (r = -0.41, p = 0.002); and Δ0 - 12 body mass index (BMI) Z-score (r = 0.30, p = 0.024); while the rate of rGFR decline in the first year was related only to baseline rGFR (r = -0.57, p < 0.001). In multivariate analysis, significant predictors of the rate of daily diuresis decline in the first year were baseline diuresis (β = -0.386, p < 0.001) and proteinuria (β = -0.278, p = 0.017), mean systolic BP Z-score (β = -0.237, p = 0.027), and age at the onset of PD (β = -0.224, p = 0.037), while predictors of the rate of rGFR decline were baseline rGFR (β = -0.607, p < 0.001) and baseline proteinuria (β = -0.225, p = 0.046). In the second year, the only predictors of the rate of rGFR decline were D/D (r = 0.44, p = 0.033, univariate analysis) and rGFR at 12 months (β = -0.499, p = 0.044). ♦ CONCLUSION: The most important risk factors for rapid RRF decline in children during the first year of chronic PD include higher baseline daily diuresis and proteinuria, and additional factors are systolic BP and age at the onset of PD; while high baseline GFR and low peritoneal transport status may be the only important factors during the second year.

Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic peritoneal dialysis

“…Studies of adult patients undergoing peritoneal dialysis suggested that hypertension, especially systolic hypertension, was an important risk factor for rapid loss of RRF: compared with patients with normal systolic blood pressure, patients with higher systolic blood pressure levels had a faster rate of residual urine decline in the first year, which was one of the independent risk factors leading to RRF loss. 15,18 The data in this study showed that the oligoanuria group had higher initial systolic and diastolic blood pressure levels; however, multivariate analysis could not sufficiently confirm that these parameters were independent risk factors for RRF loss in children receiving APD treatment. Previous studies have also suggested that antihypertensive drug use was an important risk factor for RRF loss.…”

“…The mean glucose loading in this study was quite higher than reported in the other study (101.51 g/m 2 /day vs. 52.40 g/m 2 /day). 15 This might be due to the lower initial urine volume in our cohort (659.77ml/m 2 /day vs. 1394.93 ml/m 2 /day), 15 which has been reported that different regions have various residual urine output. 7 This observed associations of higher glucose loading and daily ultrafiltration volume with a higher risk of RRF loss may reflect the efforts for enhanced dialytic fluid removal in patients with failing RRF.…”

The relationship between decline rate of residual renal function in the first year and mortality in peritoneal dialysis patients

“…Similar to previous studies [12, 13, 31–33], we found that high baseline RRF was the major predictor of the fast decline of RRF in the first year. A possible explanation for this might be that RRF was found to decline exponentially after the onset of therapy [3].…”

Study on the Efficacy of Sacubitril/Valsartan in Patients with Heart Failure with Preserved Ejection Fraction Undergoing Peritoneal Dialysis

“…Hypertension is highly prevalent in HFpEF and plays a critical role in its etiology because hypertension contributes to left ventricular hypertrophy, diastolic dysfunction, abnormal ventricular arterial coupling, and even end-organ damage [30]. Preservation of residual renal function is critical for survival in adults with end-stage renal disease receiving chronic PD [31]. After treatment, the levels of SBP, DBP, and 24-h UV of all patients were reduced, and the blood pressure level of patients treated with SAC/VAL was more significantly declined than that of the controls.…”