Abstract
BackgroundDecreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa.MethodsThis historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period. We compared the baseline characteristics of the patients according to their initial RUV (≤ 500 ml/day vs > 500 ml/day) using Student’s t, Mann-Whitney U and Chi2 tests. Linear mixed-effects models were used to search for predictors of decreased RUV by adding potentially predictive baseline covariates of the evolution of RUV to the effect of time: age, sex, diabetes mellitus, hypertension, diastolic blood pressure, diuretics, angiotensin conversion enzyme inhibitors (ACEI), angiotensin receptor blockers, hypovolemia, chronic tubulointerstitial nephropathy, left ventricular hypertrophy and initial hemodialysis characteristic. A value of p < 0.05 was considered the threshold of statistical significance.ResultsThe majority of hemodialysis patients were male (68.8%, sex ratio 2.2), with a mean age of 52.5 ± 12.3 years. The population’s RUV decreased with time, but with a slight deceleration. The mean RUV values were 680 ± 537 ml/day, 558 ± 442 ml/day and 499 ± 475 ml/day, respectively, at the initiation of HD and at 6 and 12 months later. The use of ACEI at the initiation of HD (beta coefficient 219.5, p < 0.001) and the presence of chronic tubulointerstitial nephropathy (beta coefficient 291.8, p = 0.007) were significantly associated with RUV preservation over time. In contrast, the presence of left ventricular hypertrophy at the initiation of HD was significantly associated with decreased RUV over time (beta coefficient − 133.9, p = 0.029).ConclusionsAmong incident hemodialysis patients, the use of ACEI, the presence of chronic tubulointerstitial nephropathy and reduced left ventricular hypertrophy are associated with greater RUV preservation in the first year of dialysis.
Highlights
Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD)
We identified increasing age [4, 5], female sex [4,5,6,7], diabetes [4, 5, 8], hypertension [6, 8, 9], left ventricular hypertrophy (LVH) [10], congestive heart failure [4, 5], proteinuria [11], frequent dialysis [7, 12,13,14], intradialytic hypotension [4, 5, 7, 11] and biocompatible membrane [4, 15] as relevant
These strategies include the use of angiotensin-converting enzyme inhibitors (ACE) [18], angiotensin receptor blockers (ARB) [19] and diuretics [20]; the control of hypovolemia [21], obesity [22] and high blood pressure; the avoidance of nonsteroidal anti-inflammatory drugs, aminoglycosides and radiographic contrast agents [23]; the reduction of LVH [10]; a lower dose of dialysis [13]; the use of biocompatible dialysates and dialyzers and bicarbonate rather than acetate; and the early initiation of HD [5, 24, 25]
Summary
Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). We identified increasing age [4, 5], female sex [4,5,6,7], diabetes [4, 5, 8], hypertension [6, 8, 9], left ventricular hypertrophy (LVH) [10], congestive heart failure [4, 5], proteinuria [11], frequent dialysis [7, 12,13,14], intradialytic hypotension [4, 5, 7, 11] and biocompatible membrane [4, 15] as relevant In this context, the National Kidney Foundation’s Kidney Disease Outcome Quality Initiative (KDOQI) guidelines recommended the implementation of RKF preservation strategies in dialysis patients using RUV as a surrogate indicator [16, 17].
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