Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis

Abstract

In dialyzed patients, preservation of residual renal function is associated with better survival, lower morbidity, and greater quality of life. To analyze the evolution of residual diuresis over time, we prospectively monitored urine output in 401 pediatric patients in the global IPPN registry who commenced peritoneal dialysis (PD) with significant residual renal function. Associations of patient characteristics and time-variant covariates with daily urine output and the risk of developing oligoanuria (under 100 ml/m2/day) were analyzed by mixed linear modeling and Cox regression analysis including time-varying covariates. With an average loss of daily urine volume of 130 ml/m2 per year, median time to oligoanuria was 48 months. Residual diuresis significantly subsided more rapidly in children with glomerulopathies, lower diuresis at start of PD, high ultrafiltration volume, and icodextrin use. Administration of diuretics significantly reduced oligoanuria risk, whereas the prescription of renin–angiotensin system antagonists significantly increased the risk oligoanuria. Urine output on PD was significantly associated in a negative manner with glomerulopathies (−584 ml/m2) and marginally with the use of icodextrin (−179 ml/m2) but positively associated with the use of biocompatible PD fluid (+111 ml/m2). Children in both Asia and North America had consistently lower urine output compared with those in Europe perhaps due to regional variances in therapy. Thus, in children undergoing PD, residual renal function depends strongly on the cause of underlying kidney disease and may be modifiable by diuretic therapy, peritoneal ultrafiltration, and choice of PD fluid.

Effect of Icodextrin Solution on the Preservation of Residual Renal Function in Peritoneal Dialysis Patients

“…Moreover, there is a growing concern about faster decline of RRF by icodextrin-induced higher ultrafiltration compared to glucose solution. 11 , 15 , 40 Our randomized controlled study addressed this issue and clearly demonstrated that icodextrin solution preserves RRF better than glucose solutions. This finding is unlikely to be explained by escalation of high concentration glucose solution or the use of diuretics because glucose exposure did not change in the control group throughout the study and the use of medications that could potentially affect urine volume was comparable between groups.…”

The Current State of Peritoneal Dialysis

“…139 Evidence suggests that PD is associated with better preservation of residual kidney function compared with HD, typical reported rates of loss in clearance per month being 0.25-0.28 and 0.30-0.40 ml/min per 1.73 m 2 , respectively [141][142][143][144][145][146] ; the mechanism is still debated but is likely to be in part the avoidance of intravascular volume depletion which occurs more frequently with HD. 145,146,148,149 The most studied intervention to maintain residual kidney function is the use of biocompatible solutions. 145,146,148,149 The most studied intervention to maintain residual kidney function is the use of biocompatible solutions.…”

Unmet needs and challenges for follow-up and treatment of autosomal dominant polycystic kidney disease: the paediatric perspective

“…International collaborative research approaches have shown an enormous potential to identify and characterize specific aspects of paediatric kidney disease and to generate an observational evidence base for clinical recommendations. This includes studies on estimating times to ESKD in children with chronic kidney disease [97], cardiovascular consequences of chronic kidney disease in childhood [98, 99] and courses of paediatric dialysis [100]. A more recent study, ARegPKD, is dedicated to describe the details of clinical courses of patients suffering from ARPKD [101, 102].…”