Effects of residual renal function in haemodialysis patients

Morduchowicz, G.; Winkler, J.; Zabludowski, J. R.; Boner, G

doi:10.1007/bf02768252

Cited by 42 publications

(30 citation statements)

References 6 publications

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“…Concentrations of uremic substances such as uric acid, ␤ 2 -microglobulin (␤2M), and p-cresol are substantially lower in patients with RRF as compared with anuric patients (2)(3)(4)(5)(6)(7). In addition, the need for dietary and fluid restriction is reduced, which may partly explain their better nutritional state (8) and quality of life (9).…”

Section: Introductionmentioning

confidence: 99%

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients.Design, setting, participants, & measurements Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output Ն100 ml/24 h (n ϭ 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output Ͻ100 ml/24 h, n ϭ 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models.Results Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR Ͼ 4.13 ml/min per 1.73 m 2 ), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 Ϯ 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. ConclusionsThis study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.

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Section: Introductionmentioning

confidence: 99%

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…RRF contributes significantly to the total solute clearance, 33 nutritional status, and quality of life 34 in maintenance peritoneal dialysis patients and is well recognized as an important factor influencing mortality. 18 However, few studies 3,5 have addressed the effect of RRF or RUO on mortality in hemodialysis patients. In addition to better fluid balance and solute clearance, patients with RRF have higher levels of endogenous erythropoietin than do patients without RRF.…”

Section: Discussionmentioning

confidence: 99%

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Lin

Ko³

et al. 2009

American Journal of Critical Care

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BackgroundThe relationship between residual urine output and postoperative survival in maintenance hemodialysis patients is unknown. Objective To explore the relationship between amount of urine before surgery and postoperative mortality and differences between postoperative nonanuria and anuria in maintenance hemodialysis patients. Methods A total of 109 maintenance hemodialysis patients underwent major operations. Anuria was defined as urine output <30 mL in the 8 hours before the first session of postoperative dial ysis. Propensity scores for postoperative anuria were developed. Results Postoperative residual urine output was 159.2 mL/8 h (SD, 115.1) in 33 patients; 76 patients were anuric. Preoperative residual urine output and adequate perioperative blood transfusion were positively related to postoperative urine output. Propensity-adjusted 30-day mortality was associated with postoperative anuria (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.16-17.96; P = .03), prior stroke (OR, 4.46; 95% CI, 1.43-13.89; P = .01) and higher disease severity (OR, 1.10; 95% CI, 1.00-1.21; P = .049) at the first postoperative dialysis. OR of 30-day mortality was 5.38 for nonanuria to anuria vs nonanuria to non anuria (P = .03) and 5.13 for preoperative anuria vs non anuria to nonanuria (P = .01). By Kaplan-Meier analysis, 30-day mortality differed significantly among patients for nonanuria to nonanuria, anuria, and nonanuria to anuria (log rank, P = .045). Conclusion Patients with preoperative nonanuria and postoperative anuria had higher mortality than did patients with no anuria before and after surgery and patients with anuria before surgery. Postoperative residual urine output is an important surrogate marker for disease severity. (American Journal of Critical Care. 2009;18:446-455) The focus of concerns about acute dialysis-related mortality has often been patients' disease severity before surgery.6,7 However, perioperative hemodynamic status and biochemical factors are also related to such patients' mortality, especially in patients with ESRD. Although many factors are related to surgical mortality in patients with ESRD, 8 information on the relationship between RRF and mortality in ESRD patients who undergo a major surgical procedure is limited. In addition, whether perioperative RRF independently is predictive of mortality after major surgery is not known. According to Shemin et al, 5 renal function, as measured by timed urine collections, can have either a beneficial or a protective effect in hemodialysis patients. The role of residual urine output (RUO) in hemodialysis patients is often neglected, and it remains unknown whether the results of survival studies in hemodialysis patients with anuria can be extrapolated to hemodialysis patients who still have RUO after major surgery.Because the amount of urine can be measured accurately in the intensive care unit (ICU), 9 we attempted to gauge RRF by RUO and examined the predictive value of postoperative anuria for ICU mortality among maintenance hemodialys...

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“…Patients with significant RRF are shown to have lower ß2-mocroglobulin (ß2M) levels (McCarthy, Williams et al, 1994;Montenegro, Martinez et al, 1992;Amici G, Virga et al, 1993) and thus are less prone to dialysis-associated amyloidosis (Copley JB, Lindberg et al, 2001). Preserved RRF is also associated with lower blood levels of uric acid, potassium (Morduchowicz, Winkler et al, 1994), and aluminium (Altmann , Butter et al, 1987), and higher levels of hemoglobin (Pecoits-Filho, Heimburger et al, 2002), presumably due to increased levels of endogenous erythropoietin. Hyperphosphatemia is prevalent in dialysis patients (Yavuz, Ersoy et al, 2008; and has been linked to vascular calcification and increased cardiovascular mortality in both HD and PD patients (Block, Hulbert-Shearon et al, 1998;Wang AY, Lai et al, 2006).…”

Section: Rrf and Metabolic Controlmentioning

confidence: 99%

“…RRF plays an important role in maintaining fluid balance, phosphorus control, and removal of uremic toxins in dialysis patients. The importance of RRF in hemodialysis (HD) patients is less well appreciated and it is believed that RRF declined rapidly in HD patients (Morduchowicz, Winkler et al, 1994;. Decline of RRF also contributed significantly to anemia, inflammation, and malnutrition in end-stage renal disease (ESRD) patients (Wang, Sea et al, 2001;Pecoits-Filho, Heimburger et al, 2003;Pecoits-Filho, Heimburger et al, 2002;.…”

Section: Introductionmentioning

confidence: 99%