Residual Renal Function Group Research Articles

Association of cardiovascular morbidity with residual renal function in twice weekly versus thrice weekly hemodialysis patients

Background: Chronic kidney disease is a non-communicable global problem. In patients of chronic kidney disease especially in hemodialysis patient mortality and morbidity due to atherosclerosis induced cardiovascular complications is very high despite the advances of hemodialysis procedure. Residual renal function contributes significantly to the overall health and cardiovascular morbidity of dialysis patients. So, the loss of residual renal function, especially in patients on hemodialysis, is a powerful predictor of mortality. Preserving residual renal function is the goal of nephrologists. Objective: To find the association between residual renal function and cardiovascular morbidity in twice weekly and thrice weekly hemodialysis patient. Methodology: This cross sectional study was conducted on 72 hemodialysis patients received dialysis more than three months in the dialysis centre of BSMMU and DMCH, Dhaka, Bangladesh during the period of October 2018 to September 2019. Study populations were divided into two groups on the basis of residual renal function (RRF). RRF was defined by interdialytic 24 hours urine volume and average of urinary urea and creatinine clearance. Preserved RRF was defined 24 hours urine volume more than 100 ml. Chi-square test (χ2), Student’s paired t-test and multiple regression analysis were used to find association between cardiovascular morbidity and RRF. Result: A significant difference of diastolic dysfunction, systolic dysfunction, LVH (p=0.001, p=0.001, p=0.004 respectively) was seen in between preserved RRF and without preserved RRF group but the difference of regional wall motion abnormality and valvular heart disease was found to be non-significant. In regression analysis, loss of RRF was found to be a significant predictor of cardiovascular morbidity. Conclusion: Preserved RRF was significantly associated with less frequent diastolic dysfunction, left ventricular hypertrophy and higher level of left ventricular ejection fraction compared to without preserved residual renal function in both twice weekly and thrice weekly HD patient.

The Relationship of Residual Renal Function with Cardiovascular Morbidity in Twice Weekly and Thrice Weekly Hemodialysis Patient

Background: Chronic kidney disease is a non-communicable global problem. In patients of chronic kidney disease especially in Hemodialysis patient mortality and morbidity due to atherosclerosis induced cardiovascular complications is very high despite the advances of Hemodialysis procedure. Residual renal function contributes significantly to the overall health and cardiovascular morbidity of dialysis patients. So, the loss of residual renal function, especially in patients on Hemodialysis, is a powerful predictor of mortality. Preserving residual renal function is the goal of nephrologists. Objective: To find the association between residual renal function and cardiovascular morbidity in twice weekly and thrice weekly Hemodialysis patient. Methodology: This cross sectional study was conducted on 72 Hemodialysis patients received dialysis more than three months in the dialysis centre of BSMMU and DMCH, Dhaka, Bangladesh during the period of October 2018 to September 2019. Study populations were divided into two groups on the basis of residual renal function (RRF). RRF was defined by interdialytic 24 hours urine volume and average of urinary urea and creatinine clearance. Preserved RRF was defined 24 hours urine volume more than 100ml. Chi-square test (χ2), Student’s paired t-test and multiple regression analysis were used to find association between cardiovascular morbidity and RRF. Result: A significant difference of diastolic dysfunction, systolic dysfunction, LVH (p=0.001, p=0.001, p=0.004 respectively) was seen in between preserved RRF and without preserved RRF group but the difference of regional wall motion abnormality and valvular heart disease was found to be non-significant. In regression analysis, loss of RRF was found to be a significant predictor of cardiovascular morbidity. Conclusion: Preserved RRF was significantly associated with less frequent diastolic dysfunction, left ventricular hypertrophy and higher level of left ventricular ejection fraction compared to without preserved residual renal function in both twice weekly and thrice weekly HD patient.

Serum alkaline phosphatase levels correlate with long-term mortality solely in peritoneal dialysis patients with residual renal function

Introduction: Increased serum alkaline phosphatase (ALP) is predictive of a higher mortality in patients with end-stage renal disease. However, it remains unknown whether residual renal function (RRF) influences the outcome-association of serum ALP among peritoneal dialysis (PD) patients.Methods: A total of 650 incident PD patients receiving PD catheter implantation in an institute between 1 November 2005 and 28 February 2017 were retrospectively enrolled. These patients were divided into groups with and without RRF (RRF and non-RRF groups) and those with serum ALP levels in tertiles. The Kaplan–Meier method and multivariate Cox proportional hazard models were used to analyze their outcomes based on RRF and serum ALP levels.Results: These 650 patients had a mean age of 49.4 ± 14.0 years old, their median ALP level was 74 U/L (interquartile range (IQR): 59–98). After 28-month (IQR: 14–41) follow-up, 80 patients in RRF group and 40 patients in non-RRF group died. PD patients with the highest serum ALP tertile had significant lower survival (p = .014), when compared to other patients in the RRF group. However, this relationship was not observed in patients in the non-RRF group. After multivariate adjustment, in the RRF group, patients with the highest ALP tertile had a significantly higher risk of mortality (hazard ratio (HR): 2.26, 95% confidence interval (CI): 1.06–4.82, p = .034). Each 10-U/L increase in ALP level was associated with a 4% (HR: 1.04, 95% CI: 1.00–1.08, p = .045) higher mortality risk.Conclusions: Higher serum ALP level is associated with increased mortality solely in PD patients with RRF.

The impact of residual renal function on quality of life in patients with peritoneal dialysis .

Residual renal function (RRF) is a crucial factor that plays an important role in peritoneal dialysis (PD) patients, but whether RRF influences the quality of life (QOL) of PD patients is still controversial. The aims of this study were to explore the effects of RRF on QOL in patients with continuous ambulatory peritoneal dialysis (CAPD) and analyze the related factors that might affect patients' QOL. All 120 adult patients in this study received regular CAPD treatment for at least 3 months. Patients were divided into two groups: an RRF group (residual glomerular filtration (rGFR) ≥ 1 mL×min-1×(1.73m2)-1) and a non-RRF group (rGFR ≥ 1 mL×min-1×(1.73m2)-1). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used as a reference to calculate the scores of CAPD patients for assessing their QOL. Multiple- and single-linear regression analysis was performed to analyze correlation degree of several SF-36-related indexes. The indexes of age, gender, cause of disease, complication, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), hemoglobin (HB), cholesterol, triglycerides, high- and low-density lipoprotein, normalized protein catabolic rate (nPCR), and cardiothoracic ratio (CTR) showed no difference between the two groups (RRF and non-RRF). Comparing with RRF group, the patients without RRF showed a significant difference on indexes of PD duration, urine volume, ultrafiltration volume, dialysis dose, serum albumin, potassium, Kt/V (urea reduction ratio), creatinine, calcium, phosphate, C-reactive protein (CRP), and parathyroid hormone (PTH). Single-linear regression analysis that achieved total score of SF-36 showed no correlation with rGFR, but there was a correlation of SF-36 score with CRP, creatinine, CTR, albumin, and ultrafiltration volume. These results suggested that there was no correlation between RRF and QOL in CAPD patients, but chronic inflammation, fluid overload, and malnutrition were considered as the main factors that affect patients' QOL. .

Effect of residual renal function on quality of life of patients with uremic peritoneal dialysis

Objective To explore the effect of residual renal function(RRF) on the quality of life in uremia patients with peritoneal dialysis (PD). Methods 64 patients with uremia who underwent PD for 3 months or more were selected.According to the residual glomerular filtration rate(rGFR), the patients were divided into RRF group[35 cases with rGFR≥1mL· min-1·(1.73m2)-1] and non-RRF group[29 cases with rGFR≤1mL· min-1 ·(1.73m2) -1]. The patients were followed up at 3-month intervals.The quality of life was assessed using the SF-36. Results The calcium, phosphorus, parathyroid hormone, serum creatinine, C-reactive protein, serum albumin, total urea removal, serum potassium, total urea clearance in the non-RRF group were (2.29±0.25)mmol/L, (1.68±0.42)mmol/L, 275.68 ng/L, (1 121.58±215.36)μmol/L, (11.02±14.35)mg/L, (31.01±3.26)g/L, (100±50)mL/d, (3.48±0.78)mmol/L, (1.71±0.28), respectively, which in the RRF group were (2.21±0.19)mmol/L, (1.59±0.35)mmol/L, 147.43ng/L, (872.56±264.68) μmol/L, (5.34±8.97)mg/L, (3.43±0.59)mmol/L, (33.21±4.62)g/L, (5.34±8.97)mg/L, (33.21±4.62) g/L, (800±200)mL/d, (3.79±0.59) mmol/L, (2.01±0.41), respectively, the differences between the two groups were significant (t=2.316, 2.149, 2.353, 3.881, 2.229, 7.213, 2.243, 2.212, 4745, all P 0.05). Univariate linear regression analysis showed that rGFR was not associated with SF-36 overall score.Multivariate linear regression analysis found that SF-36 overall score and serum calcium, phosphorus, parathyroid hormone, serum creatinine, C-reactive protein, peritoneal ultrafiltration volume had relevance(t=4.102, 2.412, 2.174, 4.259). Conclusion There was no significant difference in overall quality of life scores and mental health scores between the RRF group and the non-RRF group.RRF was not directly related to the quality of life of the patients. Key words: Uremia; Peritoneal dialysis; Quality of life

Simple method to estimate daily sodium intake during measurement of dialysis adequacy in chronic peritoneal dialysis patients.

Restriction of dietary sodium intake for peritoneal dialysis (PD) patients is recommended, but there is limited information on the measurement and monitoring of sodium intake. We have developed a simple method to estimate daily sodium intake during the measurement of dialysis adequacy in PD patients. A total of 83 PD patients were enrolled in the study. The patients were divided into two groups based on residual renal function (RRF). We measured total sodium removal and estimated daily sodium intake using dietary recall for one day, during the assessment of dialysis adequacy. There were 39 patients in the RRF(-) group and 44 in the RRF(+) group. In both groups, and all patients, there were significant positive correlations between sodium intake and total sodium removal: RRF(-) group, r=0.598; RRF(+) group, r=0.577; total patients, r=0.595. There were linear relationships between dietary sodium intake and total sodium removal in both groups: RRF(-) group, sodium intake (mg/d) = 19.3 × peritoneal sodium removal (mEq/d) + 211;RRF(+) group, sodium intake (mg/d) = 15.4 × total sodium removal (mEq/d) + 609. All PD patients, sodium intake (mg/d) = 15.6 × total sodium removal (mEq/d) + 646. The measurement of total sodium removal during the assessment of dialysis adequacy could be an effective and simple method to estimate dietary sodium intake in PD patients. A dietary intake of 2,000 mg of sodium corresponds to a total sodium removal of approximately 87 mEq/d.

Impact of residual renal function on clinical outcome and quality of life in patients on peritoneal dialysis.

We studied the impact of residual renal function (RRF) on clinical outcome and quality of life in 61 patients on peritoneal dialysis (PD). They were assigned to two groups, at the time of initiation of PD, based on their estimated glomerular filtration rate (eGFR). The high RRF group had eGFR ≥5 mL/min/1.73 m[2] and the low RRF group hade GFR <5 mL/min/1.73 m[2]. All patients were followed up at regular intervals for clinical and biochemical variables. Baselines characteristics including age, sex, body mass index and cause of the kidney disease were similar in both groups. The high RRF group had a higher rate of continuous ambulatory peritoneal dialysis discontinuation. The incidence of peritonitis was higher in the low RRF group. Other infections (cellulitis, gastroenteritis, sepsis) were more common in patients with low RRF, compared to the high RRF group. The quality of life as assessed by depression score, restless leg syndrome, and sleep quality were poor in patients with reduced RRF. We found that a high RRF at the time of initiation of PD, significantly decreased the incidence of infections, depression, better nutrition, and lower levels of alkaline phosphatase; providing indirect evidence of better renal clearance of phosphorous, in those with preserved RRF.

IMPACT OF RESIDUAL RENAL FUNCTION ON CHANGES OF BODY COMPOSITION IN DIABETIC CAPD PATIENTS

Purpose: Preservation of residual renal function (RRF) in peritoneal dialysis patient is essential to improve clinical outcomes. Therefore, we conducted a prospective observational study to investigate the effect of low RRF in early period on body composition changes in CAPD patients. Methods: Among new diabetic CAPD patients from May 2001 to December 2009 in our hospital, 92 patients who finished 12 month protocol (male: 48, mean age: 54.0±11.0 years) were analyzed. Patients were assigned to 4 different dialysis solution (Dianeal ® n =30, Physioneal ® n =15 and Stay-safe ® n =15, Stay-safe·Balance ® , n =32). We defined the early low RRF group ( n =10) as less than 1.5 ml/min 1.73 m 2 at 4 weeks after initiation of peritoneal dialysis. Daily ultrafiltration volume (UFV) and urine volume (UV), daily peritoneal glucose absorption, adequacy, residual renal function (RRF) and clinical indices were measured at 4 weeks and 12 months. The peritoneal equilibration test (PET) were performed at 4 weeks and 12 months. Body composition including body weight (BW), lean body mass (LBM) and fat mass were measured using bio-impedance analysis (BIA) at 4 weeks and 12 months. Delta LBM was calculated as LBM at 12 months minus LBM at 4 weeks. We analyzed the data by SPSS 17.0. Results: 1) Baseline characteristics between the early low RRF group and the non-early low RRF group were not significantly different. 2) There was significant positive correlation between RRF at 4 weeks and RRF at 12 months (p<0.01). 3) The early low RRF group showed significant lower delta LBM than non-early low RRF group (−3.1 vs. 0.95 kg, p<0.05) There were no significant differences in body weight and fat mass between the two groups. 4) The early low RRF group showed significant lower serum albumin than non-early low RRF group (3.25 vs. 3.59 g/dl, p<0.05) at 12 months. Conclusions: The low RRF in early period of peritoneal dialysis might be associated with body composition changes during the first year in CAPD patients. It is suggested that preservation of RRF in early period of peritoneal dialysis is important to improve nutritional status.

Impact of residual renal function and HCV seropositivity on plasma CD40/CD40L system and oxidative status in haemodialysis patients

Objectives We evaluated the impact of residual renal function (RRF) on oxidative stress (SOX) and CD40/CD40L system in haemodialysis (HD) patients. Design and methods We determined sCD40, sCD40L and SOX marker—Cu/Zn superoxide dismutase (Cu/Zn SOD) levels in HD patients with RRF, with anuria (A) and in healthy controls. Results sCD40 and Cu/Zn SOD plasma levels were higher in both groups of dialyzed patients compared to controls (all p < 0.001), and they were higher in A than in RRF patients (all p < 0.01). In RRF group, sCD40/sCD40L and Cu/Zn SOD were significantly higher in anti-HCV-seropositive (anti-HCV[+]) patients than in their anti-HCV[−] counterparts. This phenomenon was not observed in A group. Multiple regression analysis showed that Cu/Zn SOD, kt/V and low fibrinogen were the independent factors affecting sCD40 levels in the whole HD group. Conclusions The loss of RRF and HCV seropositivity increased plasma levels of sCD40/sCD40L and oxidative status in HD patients.

Independent effects of residual renal function and dialysis adequacy on nutritional status and patient outcome in continuous ambulatory peritoneal dialysis.

Dialysis adequacy has a major impact on outcome of continuous ambulatory peritoneal dialysis (CAPD) patients. However, there is a substantial confounding effect by residual renal function in most studies. We differentiated the effects of dialysis adequacy from those of residual renal function on nutritional status and outcome of CAPD patients. We identified 168 CAPD patients treated in our center between September 1995 and December 1996 and categorized them into three groups: 49 patients with an average total Kt/V of 1.93 +/- 0.18 and a median residual glomerular filtration rate (GFR) of 0. 07 mL/min/1.73 m(2) in the dialysis-dependent (DD) group; 48 patients with an average total Kt/V of 2.03 +/- 0.25 and a residual GFR of 2. 33 mL/min/1.73 m(2) in the residual renal function (RRF) group; and 71 patients with an average total Kt/V of 1.38 +/- 0.22 and a residual GFR of 0.05 mL/min/1.73 m(2) in the control (CTL) group. They were followed-up for 1 year to compare baseline nutritional status and 1-year morbidity. Baseline normalized protein catabolic rates (NPCR) are 1.00 +/- 0.20 and 0.96 +/- 0.19 (for RRF and DD, respectively) versus 0.89 +/- 0.16 g/kg/d for CTL (P < 0.01). Percentage lean body mass (%LBM) was 71.6 +/- 9.8 and 71.5 +/- 10.0 (for RRF and DD, respectively) versus 65.2 +/- 8.5% for CTL (P < 0. 001). No difference was seen in the nutritional status between RRF and DD groups. Duration of hospitalization for 1 year was 6.9 +/- 11. 8 days in the RRF group versus 14.9 +/- 25.1 in the DD and 10.6 +/- 11.6 days in the CTL groups (P < 0.05). The peritonitis rate was 44. 4 patient-months for the RRF group, versus 13.6 for the DD and 12.9 for the CTL groups (P < 0.05). There also was a trend toward superior 1-year technique survival in the RRF group, but the number of observations was small. There was no difference in duration of hospitalization, peritonitis rate, and technique survival between the DD and CTL groups. Short-term morbidity in patients without residual renal function appears to be independent of total Kt/V, although Kt/V may have some effects on nutritional status. The assumption that renal and peritoneal clearances are equivalent must be carefully reexamined. Further studies on the effect of dialysis adequacy in patients without residual renal function are urgently needed.

Residual renal function and post dialysis urea rebound.

Kt/v is used to estimate haemodialysis prescription and treatment adequacy and usually does not include evaluation of urea rebound. In addition urea clearance provided by the presence of residual renal function (RRF) is additive to dialytic urea clearance. Rebound is a phenomenon involving other molecules such as creatinine and phosphorus. The aim of this study was to investigate the role of RRF on post dialysis urea, creatinine and phosphorus rebounds. We investigated 7 patients with RRF (group 1) and 7 uraemic anuric patients (group 2). Urea rebound was lower in group 1 than group 2: 9.5 +/- 4% vs 18 +/- 7% (p = 0.04). Creatinine rebound and phosphorus rebound were similar in both groups 15.2 +/- 9% group 1 vs 14.6 +/- 5% group 2 (p = NS) and 16.7 +/- 7% group 1 vs 20 +/- 7% group 2 (p = NS) respectively. Our data suggest Kt/v calculated without considering rebound overestimates haemodialysis efficacy.

Residual Renal Function Affects Lipid Profile in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

To determine whether lipoprotein abnormalities associated with continuous ambulatory peritoneal dialysis (CAPD) are influenced by residual renal function (RRF). Open, nonrandomized prospective and comparative study. Single university teaching hospital dialysis unit and outpatient clinic. Twenty adult patients on standard CAPD (1-38 months) were divided into two groups: group A (RRF < or = 0.8 mL/min, n = 10) and group B (RRF > or = 1.1 mL/ min, n = 10), Patients in the two groups were matched for age, time on dialysis, body weight, body mass index, serum urea and albumin levels, peritoneal and urinary albumin losses, and peritoneal transport characteristics such as overnight 8-hour peritoneal creatinine and beta 2-microglobulin clearances and overnight B-hour effluent glucose concentrations. The degree of uremia in patients with preserved RRF (group B) was obviously lower than in patients with negligible RRF (group A), that is, patients in group B had significantly lower serum creatinine and beta 2-microglobulin levels and significantly higher weekly KT/V than group A patients. Despite the prevalence of allele 4 of apolipoprotein E genotype in group A patients, their levels of serum total cholesterol, low-density lipoprotein cholesterol, lipoprotein (a) [Lp(a)], apolipoprotein B(ApoB), and apolipoprotein A1 (ApoA1) were significantly lower than those of patients with preserved RRF (group B). The two groups did not differ significantly in the serum levels of triglyceride or high-density lipoprotein cholesterol. Serum concentrations of Lp(a) and ApoA1, as well as ratios of ApoA1 to ApoB, were correlated significantly with RRF (r = 0.63, r = 0.51, and r = 0.61, respectively). The findings suggest that RRF affects the lipid profile of CAPD patients, especially serum levels of cholesterol-rich lipoproteins.