Proteinuria as a Risk Factor for Decline in Residual Renal Function in Non-Diabetic Peritoneal Dialysis Patients

Kang, Seok Hui; Cho, Kyu Hyang; Park, Jong Won; Yoon, Kyung Woo; Young, Jun

doi:10.1159/000350145

Cited by 8 publications

(6 citation statements)

References 39 publications

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“…Moreover, proteinuria was present in all children who became anuric in the studied period, with 90.9% of them having nephrotic range proteinuria. These results, similarly to findings in adult patients (3,16,17), indicate a strong adverse effect of large proteinuria on renal function also after initiation of RRT.…”

Section: Discussionsupporting

confidence: 86%

Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

Roszkowska‐Blaim

Skrzypczyk

2016

Perit Dial Int

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♦ BACKGROUND: The aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD). ♦ METHODS: The study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m]), etiology of ESRD, PD fluid volume (mL/m/24 h), glucose load (g/m/24 h), ultrafiltration (mL/m/24 h), peritoneal permeability (D/P, D/D), dialysis adequacy (twKt/V, twCCr [L/week/1.73 m]), blood pressure (BP), biochemical parameters, and medications used. Duration of follow-up was 24 months. ♦ RESULTS: Mean diuresis before initiation of PD was 1,394.93 ± 698.37 (mL/m/24 h), and mean rGFR was 7.41 ± 3.96 (mL/min/1.73 m). The rate of daily diuresis decline was -529.34 ± 546.28 in the first year and -107.10 ± 291.54 (mL/m/24 h) in the second year (p = 0.005), and the rate of rGFR decline was -3.35 ± 3.73 in the first year and -1.63 ± 1.85 (mL/min/1.73 m) in the second year (p = 0.118). Eleven (19.64%) patients became anuric. In univariate analysis, the rate of daily diuresis decline in the first year was related to baseline diuresis (r = -0.29, p = 0.031), proteinuria (r = -0.43, p = 0.001), and systolic BP (r = -0.31, p = 0.020); 12-month changes (Δ0 - 12) in PD fluid volume (r = -0.37, p = 0.004), glucose load (r = -0.28, p = 0.035), and ultrafiltration (r = -0.38, p = 0.004); serum calcium-phosphorus product (r = -0.41, p = 0.002); and Δ0 - 12 body mass index (BMI) Z-score (r = 0.30, p = 0.024); while the rate of rGFR decline in the first year was related only to baseline rGFR (r = -0.57, p < 0.001). In multivariate analysis, significant predictors of the rate of daily diuresis decline in the first year were baseline diuresis (β = -0.386, p < 0.001) and proteinuria (β = -0.278, p = 0.017), mean systolic BP Z-score (β = -0.237, p = 0.027), and age at the onset of PD (β = -0.224, p = 0.037), while predictors of the rate of rGFR decline were baseline rGFR (β = -0.607, p < 0.001) and baseline proteinuria (β = -0.225, p = 0.046). In the second year, the only predictors of the rate of rGFR decline were D/D (r = 0.44, p = 0.033, univariate analysis) and rGFR at 12 months (β = -0.499, p = 0.044). ♦ CONCLUSION: The most important risk factors for rapid RRF decline in children during the first year of chronic PD include higher baseline daily diuresis and proteinuria, and additional factors are systolic BP and age at the onset of PD; while high baseline GFR and low peritoneal transport status may be the only important factors during the second year.

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Section: Discussionsupporting

confidence: 86%

Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

Roszkowska‐Blaim

Skrzypczyk

2016

Perit Dial Int

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“…Since data in table 3 suggested that the patients treated with fewer initial HD frequency had less incidence of RKF loss than patients treated with regular thrice-weekly HD, a Receiver Operating Characteristic (ROC) analysis was performed to decide the cut-off value of a 50% decline rate of GFR in a year for predicting whether the patient has lost RKF or not, as previously reported [35,36]. We found the best cut-off value was 0.044 (4.4%) with a specificity of 75% and a sensitivity of 64% (AUC = 0.65, p < 0.05) (see online suppl.…”

Section: Resultsmentioning

confidence: 99%

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

et al. 2014

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Background: Residual kidney function (RKF) has consistently been a predictor of greater survival in maintenance hemodialysis (MHD) patients. The relationship between hemodialysis (HD) treatment frequency and RKF preservation has not been well examined. We hypothesized that initial twice-weekly HD helps in maintaining a longer RKF. Methods: In a dialysis center in Shanghai, 168 ESRD patients were screened and finally 85 patients were identified for this main cohort study. We first examined these 85 MHD patients; 30 of them were initiated with twice-weekly HD for 6 months or longer and 55 patients were started and maintained on thrice-weekly HD treatment. Then a subcohort study in 48 incident MHD patients was implemented to assess the independent risk factors responsible for RKF decline during the first year of HD therapy. Multivariate logistic regression analysis was then employed to examine the odds ratio of RKF loss. Results: The main cohort study showed that the clinical outcomes were almost the same between the two groups in 85 patients, but the percent of patients with RKF loss was significantly lower in the twice-weekly group compared with the thrice-weekly group, especially during the first year of HD initiation. In the 48 incident MHD patients, we found no significant differences between the two groups except for variations in the HD frequency, weekly Kt/V. The multivariate analysis showed that factors such as the male gender, HD frequency, URR and intradialytic hypotension episode were associated with RKF loss, and the odds ratio of RKF loss for each additional HD treatment per week was 7.2. Conclusion: Twice-weekly HD during the first year of dialysis therapy appears to be associated with better RKF preservation.

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“…In this study, patients in the early peritonitis group were older and exhibited a lower ALB level, either of which can negatively impact patient outcomes. Besides, lower ALB level and proteinuria may cause decline in residual renal function, which can worsen the prognosis of PD patients [20].…”

Section: Discussionmentioning

confidence: 99%

Early Peritonitis is an Independent Risk Factor for Mortality in Elderly Peritoneal Dialysis Patients

Zhi

Jiang

Feng

et al. 2015

Kidney Blood Press Res

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Background/Aims: The impact of early peritonitis on the outcome of elderly peritoneal dialysis (PD) patients has not been studied. We aimed to research the influence of early peritonitis on patient outcomes in elderly PD patients. Methods: This study involved elderly PD patients (age ≥65) who underwent PD between Jan 1, 2004 and Jul 31, 2013. Patient characteristics were collected in our database. Early peritonitis was defined as peritonitis within 6 months after the initiation of PD. Patient survival and technique were compared among the non-peritonitis, early peritonitis and late peritonitis groups using Cox regression analysis. Results: There were 155 subjects involved in this study. The patients were divided among a non-peritonitis group (n=78), early peritonitis group (n=32) and late peritonitis group (n=45). The organisms causing first peritonitis in the two groups did not differ significantly. After adjustment for age, diabetes, serum albumin and residual renal function, multivariable Cox regression model revealed that compared with the early peritonitis group, both the non-peritonitis group (HR 0.57, RI 0.32-0.99, p=0.046) and the late peritonitis group (HR 0.37, RI 0.16-0.75, p=0.004) exhibited a lower patient mortality rate. Conclusions: Early peritonitis is an independent risk factor for mortality in elderly peritoneal dialysis patients.

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Proteinuria as a Risk Factor for Decline in Residual Renal Function in Non-Diabetic Peritoneal Dialysis Patients

Cited by 8 publications

References 39 publications

Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

Early Peritonitis is an Independent Risk Factor for Mortality in Elderly Peritoneal Dialysis Patients

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