Impact of residual urine volume decline on the survival of chronic hemodialysis patients in Kinshasa.

Vieux Momeme Mokoli,Désiré Kulimba Mashinda,Justine Busanga Bukabau,Jean Robert Rissassy Makulo,Jeannine Losa Luse,Ernest Kiswaya Sumaili,Nazaire Mangani Nseka,Stéphane Kalambay Mukendi,François Bompeka Lepira,Patrick Parmba Osa Izeidi

doi:10.1186/s12882-016-0401-9

Vieux Momeme Mokoli, Désiré Kulimba Mashinda + Show 8 more

Open Access

https://doi.org/10.1186/s12882-016-0401-9

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Abstract

BackgroundDespite the multiple benefits of maintaining residual urine volume (RUV) in hemodialysis (HD), there is limited data from Sub-Saharan Africa. The aim of this study was to assess the impact of RUV decline on the survival of HD patients.MethodsIn a retrospective cohort study, 250 consecutive chronic HD patients (mean age 52.5 years; 68.8% male, median HD duration 6 months) from two hospitals in the city of Kinshasa were studied, between January 2007 and July 2013. The primary outcome was lost RUV. Preserved or lost RUV was defined as decline RUV < 25 (median decline) or ≥ 25 ml/day/month, respectively. The second endpoint was survival (time-to death). Survival curves were built using the Kaplan-Meier methods. We used Log-rank test to compare survival curves. Predictors of mortality were assessed by Cox proportional hazards regression models.ResultsThe cumulative incidence of patients with RUV decline was 52, 4%. The median (IQR) decline in RUV was 25 (20.8–33.3) ml/day/month in the population studied, 56.7 (43.3–116.7) in patients deceased versus 12.9 (8.3–16.7) in survivor patients (p < 0.001). Overall mortality was 78 per 1000 patient years (17 per 1000 in preserved vs 61 per 1000 lost RUV). Forty six patients (18.4%) died from withdrawal of HD due to financial constraints. The Median survival was 17 months in the whole group while, a significant difference was shown between lost (10 months, n = 119) vs preserved RUV group (30 months, n = 131; p = 0001). Multivariate Cox proportional hazards models showed that, decreased RUV (adjusted HR 5.35, 95% CI [2.73–10.51], p < 0.001), financial status (aHR 2.23, [1.11–4.46], p = 0.024), hypervolemia (a HR 2.00, [1.17–3.40], p = 0.011), lacking ACEI (aHR 2.48, [1.40–4.40], p = 0.002) or beta blocker use (aHR 4.04, [1.42–11.54], p = 0.009), central venous catheter (aHR 6.26, [1.71–22.95], p = 0.006), serum albumin (aHR 0.93, [0.89–0.96], p < 0.001) and hemoglobin (aHR 0.73, [0.63–0.84], p < 0.001) had emerged as the independent predictors of all-cause mortality.ConclusionMore than half of HD patients in this cohort study experienced fast RUV decline which contributed substantially to increase mortality, highlighting the need for its prevention and management.

Highlights

Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialysis (HD), there is limited data from Sub-Saharan Africa
Multivariate Cox proportional hazards models showed that, decreased RUV, financial status, hypervolemia, lacking ACEI or beta blocker use, central venous catheter, serum albumin and hemoglobin had emerged as the independent predictors of all-cause mortality
Data are expressed as numbers and proportions in parentheses or mean ± standard deviation, median as appropriate Abbreviations: BMI: body mass index, Systolic blood pressure (SBP): systolic blood pressure, DBP: diastolic blood pressure, PP: pulse pressure, HIVAN: human Immunodeficiency virus associated nephropathy, Initial residual urine volume (IRUV): initial residual urine volume, RUV: residual urine volume, Angiotensin conversion enzyme (ACE): angiotensin conversion enzyme inhibitor, EPO: erythropoietin, Arterio-venous fistula (AVF): arterio-venous fistula, Kt/V urea: clearance of urea ml/min based on the volume of distribution, HD: hemodialysis, CRP: C reactive protein

Summary

Introduction

Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialysis (HD), there is limited data from Sub-Saharan Africa. In Japan and Taiwan, a 5-year survival was estimated at 56.7% and 56% respectively [3, 4]. This high mortality in the developed countries has motivated the search and identification of potential predictors to help improving the survival of dialysis patients. This approach has the advantage of improving individual and collective acceptance of dialysis and rational use of the available resources, especially in resource-limited countries where any death of dialysis patient could lead to a reluctance of patients to accept this treatment

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