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Residual renal function and mortality risk in hemodialysis patients

      Abstract

      Residual renal function, defined as the urinary clearance of urea and creatinine, is minimal in many patients treated with hemodialysis (HD) and tends to be ignored in most outcome studies involving HD patients. Recent studies showed that residual renal function, even at a low level, is influential in preventing mortality in the minority of patients with end-stage renal disease treated with peritoneal dialysis. This issue generally has not been examined in patients treated with HD. This prospective observational study of all 114 patients at a single community-based freestanding HD center is designed to examine the impact of residual renal function (defined as renal urea clearance and renal creatinine clearance derived from 24-hour urinary volumes) on mortality over a 2-year period. During that period, 50 deaths occurred in 114 patients. The presence of residual renal function was protective against mortality (odds ratio for death, 0.44; 95% confidence interval, 0.24 to 0.81; P = 0.008), even after adjustment for duration of dialysis treatment, age, smoking, presence of diabetes, presence of cardiovascular disease, serum albumin level, and urea reduction rate. In conclusion, the presence of residual renal function, even at a low level, is associated with a lower mortality risk in HD patients. © 2001 by the National Kidney Foundation, Inc.

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      References

        • Churchill DN
        • Taylor DW
        • Keshaviah PR
        Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes.
        J Am Soc Nephrol. 1996; 7: 198-207
        • Moist LM
        • Port FK
        • Orzol SM
        • Young EW
        • Ostbye T
        • Wolfe RA
        • Hulbert-Shearon T
        • Jones CA
        • Bloembergen WE
        Predictors of loss of residual renal function among new dialysis patients.
        J Am Soc Nephrol. 2000; 11: 556-564
        • Skov PE
        Glomerular filtration rate in patients with severe and very severe renal insufficiency.
        Acta Med Scand. 1970; 187: 419-428
        • Milutonovic J
        • Cuter RE
        • Hoover P
        • Meijsen B
        • Scrib-ner BH
        Measurement of residual glomerular filtration rate in the patient receiving repetitive hemodialysis.
        Kidney Int. 1975; 8: 185-190
        • Swan SK
        • Halstenson CE
        • Kasiske BL
        • Collins AJ
        Determination of residual renal function with iohexol clearance in hemodialysis patients.
        Kidney Int. 1996; 49: 232-235
        • Shemin D
        • Bostom AG
        • Lambert C
        • Hill C
        • Kitsen J
        • Kliger AS
        Residual renal function in a large cohort of peritoneal dialysis patients: Change over time, impact on mortality and nutrition.
        Perit Dial Int. 2000; 20: 439-444
        • Lowrie EG
        • Laird NM
        • Parker TF
        • Sargent JA
        Effect of the hemodialysis prescription on patient morbidity.
        N Engl J Med. 1981; 305: 1176-1181
        • Owen WF
        • Lew NL
        • Liu Y
        • Lowrie EG
        • Lazarus JM
        The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.
        N Engl J Med. 1993; 329: 1001-1006
        • Bonomini V
        • Albertazzi A
        • Vangelista A
        • Bortolotti GC
        • Stefoni S
        • Scolari MP
        Residual renal function and effective rehabilitation in chronic dialysis.
        Nephron. 1976; 16: 89-99
        • Merkus MP
        • Jager KJ
        • Dekker FW
        • de Haan RJ
        • Boeschoten EW
        • Krediet RT
        Predictors of poor outcome in chronic dialysis patients: The Netherlands Cooperative Study on the Adequacy of Dialysis.
        Am J Kidney Dis. 2000; 35: 69-79
        • Ravid M
        • Lang B
        • Robson M
        The importance of daily urine volume and residual renal function in patients treated with chronic hemodialysis.
        Dial Transplant. 1980; 9: 763-765
        • Suda T
        • Hiroshoge K
        • Ohta T
        • Watanabe Y
        • Iwomoto M
        • Kanegae K
        • Ohtani A
        • Nakashima Y
        The combination of residual renal function to overall nutritional status in chronic hemodialysis patients.
        Nephrol Dial Transplant. 2000; 15: 396-401
        • Renal Data System US
        USRDS 2000 Annual Data Report.
        The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases,, Bethesda, MD1997
        • McCarthy JT
        • Jensen BM
        • Squillace DP
        • Williams AW
        Improved preservation of residual renal function in chronic hemodialysis patients using polysulfone dialyzers.
        Am J Kidney Dis. 1997; 29: 576-583
        • Hartmann J
        • Fricke H
        • Schiffl H
        Biocompatible membranes preserve residual renal function in patients undergoing regular hemodialysis.
        Am J Kidney Dis. 1997; 30: 366-373