Preservation of Residual Renal Function — An Important Goal

Venkataraman, Vijaya; Nolph, Karl D.

doi:10.1177/089686080002000405

Cited by 24 publications

(14 citation statements)

References 22 publications

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“…In CAPD, patients' removal of water is performed every day and during most parts of the day, depending on the prescription of dialysis fluids. Thereby, the change in body weight is very limited, while in those on intermittent peritoneal dialysis the reduction in residual renal function is close to that for HD (3).…”

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confidence: 80%

Ultrafiltration and Dry Weight—What Are the Cardiovascular Effects?

Stegmayr¹

2003

Artificial Organs

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Long-term prognosis in dialysis is poor compared to that in healthy control persons. A worsening of the prognosis is noted especially for patients who at initiation of dialysis have congestive heart failure, ischemic heart disease, or left ventricular dysfunction or hypertrophy. This is the main reason that cardiovascular causes are the most common for morbidity in these patients. The weight obtained when normal urine output is present is the dry weight. With reduced ability to excrete the volume by the kidneys in end-stage renal disease (ESRD), the body will retain water and the patient will gain weight. This extra weight is due to volume overload. While volume overload may induce a rise in blood pressure, if the heart is in acceptable condition, a fast removal of fluid by ultrafiltration (UF) during dialysis may instead cause hypotension. Ultrafiltration failure in peritoneal dialysis (PD) patients may lead to successive water retention and overhydration with subsequent cardiac failure, while volume overload may occur over a few days in hemodialysis (HD) patients. Anemia or even too-high hematocrit may impair cardiac function further and worsen conditions caused by wrong dry weight. Thus, during long-term and sustained volume overload, left ventricular (LV) hypertrophy will occur in an eccentric manner. A sustained overload then may lead to cell death and LV dilatation and, eventually, systolic dysfunction. Once a severe left ventricular dilatation has developed, the blood pressure may decrease during volume overload. A worsened prognosis is seen if malnutrition and low albumin levels are present. Volume overload necessitates ultrafiltration to achieve dry weight. Thereby, volume contraction contributes to exaggerated stimulation of or response to activation of the RAS and alpha-adrenergic sympathetic systems. If ultrafiltration goes beyond these compensatory mechanisms, hypotension will occur and increase the risk for hypoperfusion of vital organs. Such episodes may cause cardiac morbidity, aspiration pneumonia, vascular access closure, or neurological complications (seizures, cerebral infarction), besides a more rapid lowering of residual renal function. Preventive measures are, first, finding the right dry weight; second, minimizing interdialytic weight gain; third, optimizing the target for hemoglobin (110-120 g/l); fourth, lowering dialysate calcium (1.25 mmol/l); and fifth, eventually using higher dialysate potassium if long dialyses are performed.

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confidence: 80%

Ultrafiltration and Dry Weight—What Are the Cardiovascular Effects?

Stegmayr¹

2003

Artificial Organs

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“…Maintenance of RRF contributes to enhance the efficacy of renal replacement therapy and reduces dietary fluid restriction but it should never be considered as a primary goal of dialysis adequacy in dialysis patients. 64,65 Tight control of the extracellular volume should be a priority at any time in dialysis patients in order to prevent the deleterious cardiovascular consequences of chronic fluid overload.…”

Section: Resultsmentioning

confidence: 99%

Residual renal function and dialysis modality: Is it really beneficial to preserve residual renal function in dialysis patients? (Review Article)

Canaud

Chénine²,

Leray‐Moragues³

et al. 2006

Nephrology

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SUMMARY:Residual renal function (RRF) contributes to the achievement of treatment adequacy in stage 5 chronic kidney disease (CKD-5) patients. It may facilitate patients' acceptance of renal replacement therapy (RRT) in allowing reduction of treatment time duration and minimising dietary and fluid restriction. It has been confirmed to improve dialysis patient outcomes. Attempts to preserve RRF in incident Stage 5 chronic kidney disease patients are still subject to intense controversies in the nephrology community. The aim of this review is to analyse the role of renal replacement modalities in the maintenance of RRF in dialysis patients. Under the scope of this manuscript, four questions are explored: Is the preservation of residual renal function an objective for dialysis adequacy? Does dialysis modality affect the decline of RRF? What are the factors implicated by this loss of RRF? At what expense can the maintenance of RRF be achieved in dialysis patients? Preservation of RRF is undoubtedly an interesting means to enhance the efficacy of renal replacement therapy and reduce dietary fluid restriction but it should not be considered as a goal of dialysis adequacy in dialysis patients. Further, preservation of RRF must be considered as a permanent trade-off between patient comfort and chronic fluid volume overload.

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“…However, in patients with RRF in particular those on peritoneal dialysis (PD), the choice of imaging modality is less clear. The preservation of RRF has been shown to be an important predictor of survival in patients on PD (18–21). However, evidence has arisen to suggest that patients on PD may be at a higher risk of developing NSF in comparison to those on hemodialysis (38).…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta‐analysis reported a sensitivity and specificity of detecting solely significant stenotic or occlusive aortoiliac disease of 96% (91–99%) and 98% (95–99%), respectively (16). However, ionizing radiation and the required use of potentially nephrotoxic iodinated contrast agents are of concern in patients with ESRD depending on the mode of dialysis and the presence or absence of residual renal function (RRF) (17–21).…”

Section: Imaging In Peripheral Arterial Diseasementioning

confidence: 99%

Who should have pelvic vessel imaging prior to renal transplantation?

Subesinghe

Cherukuri

Ecuyer³

et al. 2011

Clinical Transplantation

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Current guidelines are vague in their recommendations as to which patients should be imaged prior to renal transplantation and the optimal imaging modality for this purpose. Data on 112 patients who underwent pre-transplant vascular imaging (magnetic resonance angiography or contrast angiography), from a total of 167 evaluated between January 2005 and October 2006, were scrutinized to see whether abnormal results altered clinical management. Several variables were analyzed to determine possible predictors of an abnormal scan result. Sixty-nine patients (61.6%) were either diabetic or aged over 60. Fifty-nine (52.7%) were normal scans, and 53 (47.3%) were abnormal. In the abnormal group, 21 (18.8%) clinical decisions were made. Multivariate analysis revealed that age (OR: 1.1, 1.03-1.13) and diabetes (OR: 3.2, 1.13-9.2) were significant predictors of an abnormal scan. Imaging delayed transplant listing by 83 days. Imaging for all potential transplant recipients is not required and results in unnecessary delay. Risk factors including age and diabetes can be utilized to rationalize imaging via clinical guidelines to target to high-risk groups. The choice of imaging modality in patients with renal insufficiency is not clear cut, but risks and benefits should be addressed on an individual basis and preventative strategies used whenever possible.

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Preservation of Residual Renal Function — An Important Goal

Cited by 24 publications

References 22 publications

Ultrafiltration and Dry Weight—What Are the Cardiovascular Effects?

Ultrafiltration and Dry Weight—What Are the Cardiovascular Effects?

Residual renal function and dialysis modality: Is it really beneficial to preserve residual renal function in dialysis patients? (Review Article)

Who should have pelvic vessel imaging prior to renal transplantation?

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