The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients

Suda, Takafumi; Hiroshige, Kinya; Ohta, Takayuki; Watanabe, Yujiro; Iwamoto, Masako; Kanegae, Kaori; Ohtani, Akira; Nakashima, Yasuhide

doi:10.1093/ndt/15.3.396

Cited by 112 publications

(96 citation statements)

References 23 publications

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“…35 RRF also contributes to overall nutritional status in maintenance hemodialysis patients. 36 Hemodialysis patients with stable urine output have a greater lean body mass, an indicator of nutritional status in maintenance hemodialysis patients, than do those without RRF, 36 a finding that is consistent with our findings. Loss of RRF has been associated with an increased inflammatory response 37 and may enhance an inflammatory response via increased oxidative stress, a situation that may lead to activation of monocytes and production of cytokines.…”

Section: Discussionsupporting

confidence: 90%

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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Section: Discussionsupporting

confidence: 90%

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Lin

Ko³

et al. 2009

American Journal of Critical Care

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“…Detection of creatinine and urea clearance is a heavy burden for chronic dialysis patients because it requires collection of urine for 24 h. Therefore, some studies used the dialysis between 24 h urine to evaluate RRF. 1,21,22 Moist et al 22 showed that the urine of hemodialysis patients was positively correlated with the inulin clearance rate (correlation coefficient: 0.71) and the correlation coefficient of urine for 24 h with the mean of creatinine and urea clearance was 0.57 (p ¼ 0.001). Van Olden et al 23 also observed a significant positive correlation between GFR and urine volume for 24 h. These results support that 24 h urine volume is an effective indicator for the evaluation of RRF.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies also used this indicator to define RRF loss (24 h urine < 200 mL). 21,22 Under the hemodialysis condition, it is required to clear 60-70 L plasma water weekly in order to ensure the removal of the body's toxin. Studies have shown that the RRF is 1 mL/min, which is equivalent to the weekly removal of approximately 10 L of plasma water.…”

Section: Discussionmentioning

confidence: 99%

Effects of Residual Renal Function on Left Ventricle and Analysis of Related Factors in Patients with Hemodialysis

Ding

2012

Renal Failure

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Background: Left ventricular hypertrophy (LVH) and systolic dysfunction would predict the mortality of patients undergoing maintenance hemodialysis. The cause of LVH is usually related to the increase of total peripheral vascular resistance and overloading volume. The presence of residual diuresis enables greater control of the volume. This study evaluated the effects of residual renal function (RRF) on the left ventricle and analyzed the related factors involved in hemodialysis patients. Methods: A total of 59 hemodialysis patients were classified into two groups. The patients in the RRF (RRFþ) group had a urine volume greater than 200 mL/24 h, and the patients in the non-RRF (RRFÀ) group had a urine volume less than 200 mL/24 h. B-type natriuretic peptide (BNP), blood total homocysteine (tHcy), and blood biochemical indexes were determined for the patients in both groups. Echocardiography and Doppler tests were performed to determine the cardiac indexes. Results: LVH and systolic dysfunction in the RRFþ group were less severe than those in the RRFÀ group. The concentration of tHcy and BNP in patients with RRF was decreased in comparison with those without RRF. The concentration of tHcy and BNP was positively correlated with the residual diuresis. Conclusions: There were distinct ventricular geometric patterns and different functional performances between RRFþ and RRFÀ groups. The presence of residual diuresis had a beneficial effect on the left ventricular function in hemodialysis patients.

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“…The residual renal function is probably an important predictor of outcome in HD patients as well (14,15). However, the relative contribution of residual renal Kt/V urea (rKt/V urea ) versus delivered Kt/V urea (dKt/V urea ) to patient outcome remains to be established for HD patients.…”

mentioning

confidence: 99%

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Termorshuizen

Dekker²,

Manen³

et al. 2004

Journal of the American Society of Nephrology

317

273

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Abstract.A high delivered Kt/V urea (dKt/V urea ) is advocated in the U.S. National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines on hemodialysis (HD) adequacy, irrespective of the presence of residual renal function. The contribution of treatment adequacy and residual renal function to patient survival was investigated. The Netherlands Cooperative Study on the Adequacy of Dialysis is a prospective multicenter study that includes incident ESRD patients older than 18 yr. The longitudinal data on residual renal function and dialysis adequacy of patients who were treated with HD 3 mo after the initiation of dialysis (n ϭ 740) were analyzed. The mean renal Kt/V urea (rKt/V urea ) at 3 mo was 0.7/wk (SD 0.6) and the dKt/V urea at 3 mo was 2.7/wk (SD 0.8). Both components of urea clearance were associated with a better survival (for each increase of 1/wk in rKt/V urea , relative risk of death ϭ 0.44 [P Ͻ 0.0001]; dKt/V urea , relative risk of death ϭ 0.76 [P Ͻ 0.01]). However, the effect of dKt/V urea on mortality was strongly dependent on the presence of rKt/V urea , low values for dKt/ V urea of Ͻ2.9/wk being associated with a significantly higher mortality in anuric patients only. Furthermore, an excess of ultrafiltration in relation to interdialytic weight gain was associated with an increase in mortality independent of dKt/V urea . In conclusion, residual renal clearance seems to be an important predictor of survival in HD patients, and the dKt/V urea should be tuned appropriately to the presence of renal function. Further studies are required to substantiate the important role of fluid balance in HD adequacy.

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The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients

Abstract: Over half of our HD patients had sufficient RRF. RRF itself may have a beneficial effect on nutritional parameters, and it is important to determine RRF over time, even in chronic HD patients.

Cited by 112 publications

References 23 publications

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Effects of Residual Renal Function on Left Ventricle and Analysis of Related Factors in Patients with Hemodialysis

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

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