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Lim JH, Seo YJ, Jeon Y, Jeon YH, Jung HY, Choi JY, Park SH, Kim CD, Kang SH, Ryu JH, Kang DH, Cho JH, Kim YL. Expanded Hemodialysis with Theranova Dialyzer and Residual Kidney Function in Patients Starting Long-Term Hemodialysis: A Randomized Controlled Trial. J Am Soc Nephrol 2025:00001751-990000000-00578. [PMID: 40036081 DOI: 10.1681/asn.0000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 02/27/2025] [Indexed: 03/06/2025] Open
Abstract
Background Expanded hemodialysis using a medium cutoff dialyzer improves the clearance of middle-molecular toxins compared with conventional hemodialysis. This study evaluated the effect of expanded hemodialysis on preserving residual kidney function in patients starting treatment with long-term hemodialysis. Methods Patients who initiated long-term hemodialysis were randomized to receive dialysis with either a Theranova 400 (Baxter) or a high-flux dialyzer with a similar surface area over 12 months. The primary outcome was a change in GFR over 12 months, as determined by the mean of urea and creatinine clearance. The secondary outcome was a change in 24-hour urine volume, middle molecules, and kidney injury markers. Results A total of 80 patients on hemodialysis (mean age [SD]: 63 [12] years; male: 52 [65%]) underwent randomization. Over 12 months, the Theranova group demonstrated a significantly smaller decrease in GFR than the high-flux group (least squares mean difference of change [95% confidence interval], −1.4 [−2.4 to −0.5] ml/min per 1.73 m2). Theranova maintained greater 24-hour urine volume until 9 months, not at 12 months, compared with the high-flux dialyzer. The reduction ratio for κ/λ free light chains, TNF-α, and growth differentiation factor-15 was higher in the Theranova group than in the high-flux group. The increase in the kidney injury marker, IGF-binding protein 7, was attenuated in the Theranova group. Hospitalization rate and mortality did not differ between the two groups. Conclusions This trial suggests that expanded hemodialysis using the Theranova dialyzer slowed decline in residual kidney function compared with a high-flux dialyzer in patients starting treatment with long-term hemodialysis.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yu Jin Seo
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Yena Jeon
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California
| | - You Hyun Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seok Hui Kang
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jung-Hwa Ryu
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, Republic of Korea
| | - Duk-Hee Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Dopierała M, Schwermer K, Hoppe K, Kupczyk M, Pawlaczyk K. Benefits of Preserving Residual Urine Output in Patients Undergoing Maintenance Haemodialysis. Int J Nephrol Renovasc Dis 2023; 16:231-240. [PMID: 37868106 PMCID: PMC10590073 DOI: 10.2147/ijnrd.s421533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients' well-being and mortality risk. One of them is the presence of residual urine output. Materials and Methods The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output (<=100mL per day, >100mL to <=500mL, >500mL to <=1000mL and >1000mL). Results The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT. Conclusion In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients.
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Affiliation(s)
- Mikołaj Dopierała
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Schwermer
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Hoppe
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Kupczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Tanriover C, Ucku D, Basile C, Tuttle KR, Kanbay M. On the importance of the interplay of residual renal function with clinical outcomes in end-stage kidney disease. J Nephrol 2022; 35:2191-2204. [PMID: 35819749 DOI: 10.1007/s40620-022-01388-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease (CKD) is one of the most important public health concerns of the century, and is associated with high rates of morbidity, mortality and social costs. CKD evolving towards end-stage kidney disease (ESKD) is on the rise resulting in a greater number of patients requiring peritoneal dialysis (PD) and hemodialysis (HD). The aim of this manuscript is to review the current literature on the interplay of residual renal function (RRF) with clinical outcomes in ESKD. The persistence of RRF is one of the most important predictors of decreased morbidity, mortality, and better quality of life in both PD and HD patients. RRF contributes to the well-being of ESKD patients through various mechanisms including higher clearance of solutes, maintenance of fluid balance, removal of uremic toxins and control of electrolytes. Furthermore, RRF has beneficial effects on inflammation, anemia, malnutrition, diabetes mellitus, obesity, changes in the microbiota, and cardiac diseases. Several strategies have been proposed to preserve RRF, such as blockade of the renin-angiotensin-aldosterone system, better blood pressure control, incremental PD and HD. Several clinical trials investigating the issue of preservation of RRF are ongoing. They are needed to broaden our understanding of the interplay of RRF with clinical outcomes in ESKD.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Katherine R Tuttle
- Division of Nephrology, University of Washington, Seattle, WA, USA.,Providence Medical Research Center, Providence Health Care, Washington, USA
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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4
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Choudhury D, Yalamanchili HB, Hasan A. Dialysis of the Obese Patient: Meeting Needs for a Growing Epidemic. Semin Nephrol 2021; 41:371-379. [PMID: 34715966 DOI: 10.1016/j.semnephrol.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasing population obesity and associated metabolic consequences has led to increased number of obese patients with chronic kidney disease and end-stage renal disease. While obesity is associated with increased cardiovascular morbidity and mortality, obese dialysis patients present a seeming paradox for survival benefit, given other acute intervening illnesses for those on dialysis with loss of lean body mass overtime. Challenges remain in providing adequate renal replacement options and therapy for this growing segment of obese patients on dialysis which are discussed in this article.
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Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA.
| | - Hima Bindu Yalamanchili
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Alia Hasan
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA
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Jameel FA, Junejo AM, Ejaz A, Khan QUA, Bhopal KF, Faraz A, Rizvi SHM, Ahmad F, Tahir M. Association of Pulmonary Hypertension With End-Stage Renal Disease Among the Obese Population. Cureus 2020; 12:e9722. [PMID: 32944441 PMCID: PMC7489319 DOI: 10.7759/cureus.9722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Pulmonary hypertension (PH) is a known complication that occurs in patients of end-stage renal disease (ESRD) that have an arteriovenous fistula (AVF) for hemodialysis (HD). It is defined as pulmonary artery pressure (PAP) of greater than 30 mmHg on echocardiography. The presence of PH in ESRD is an independent risk factor and decreases the survival likelihood among HD patients. Unexplained PH is frequently seen in ESRD following AVF. Obesity can lead to various complications, such as sleep apnea, cardiac complications, pulmonary hypertension, and mortality. Data on the prevalence of coexisting PH and obesity are scarce. Obese patients often have increased albumin excretion rates (AER) that can lead to early renal impairment and an increase in intraglomerular pressure, which may increase the risk of cardiovascular (CV) morbidity and mortality. Therefore, the study aimed to evaluate and compare the associated PH and obesity separately and collectively among ESRD patients. Methods This comparative cross-sectional study was conducted in a tertiary care public sector hospital with the approval of the medical ethics review board committee. The study enrolled all consecutive patients with ESRD as defined by having an estimated glomerular filtration rate (GFR) of <15 mL/min/1.7 3 m2 from April 2017 till March 2019, who presented to our facility. These patients underwent dialysis twice or thrice a week, each session lasting three to four hours approximately. On initial encounter, trans-thoracic echocardiography (TTE) was done by the cardiologist to diagnose pulmonary hypertension. In addition, body mass index (BMI) was calculated for all patients, and the patients were categorized into underweight, normal, overweight, or obese. All patients underwent post-dialysis TTE at one hour or when patients were at the optimal dry weight. Systolic PAP and ejection fraction were measured, and pulmonary hypertension was defined as a PAP of 30 mmHg or greater on TTE. ESRD patients that were diagnosed with PH prior to hemodialysis or had primary PH were excluded from the study. Only ESRD patients developing secondary PH after hemodialysis were included in the study. The chi-square test was used to see the correlation of gender, ambulation status, smoking status, obesity, pulmonary hypertension, body mass index (BMI), and pulmonary hypertension and obesity combined on the final outcome. A p-value of 0.05 was considered significant. Odds ratio (OR) and relative risk (RR) were calculated for pulmonary hypertension and obesity combined, obesity, and pulmonary hypertension in the final outcome. Results The study enrolled 204 patients with a mean age of 46.23 (±20.45 SD) having higher female participation of 108 (52.9%), whereas 96 (47.1%) were males. The average weight of the cohort was 66.78 kg (±22.98 SD) with a mean BMI of 29.91 kg/m2 (±13.29SD), 52 (25.5%) patients were underweight, 40 (19.6%) had a normal BMI, 29 (14.2%) were overweight, and 83 (40.7%) patients were obese. Pulmonary hypertension and obesity combined were observed in 48 (23.5%) of the cases and there was a 4.60 relative risk of death among these individuals, with an odds ratio of 13.35 and a p-value of 0.00. Conclusion The study shows a strong synergistic effect of pulmonary hypertension and obesity towards the final survival outcome in ESRD patients who are on hemodialysis.
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Affiliation(s)
| | | | - Ayesha Ejaz
- Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Kamran Faisal Bhopal
- Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Ahmad Faraz
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | | | - Fatima Ahmad
- Anaesthesia, Punjab Institute of Cardiology, Lahore, PAK
| | - Muhammad Tahir
- Orthopaedics, Jinnah Postgraduate Medical Center, Karachi, PAK
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Hecking M, McCullough KP, Port FK, Bieber B, Morgenstern H, Yamamoto H, Suri RS, Jadoul M, Gesualdo L, Perl J, Robinson BM. Self-reported Urine Volume in Hemodialysis Patients: Predictors and Mortality Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2019; 74:425-428. [PMID: 31005373 DOI: 10.1053/j.ajkd.2019.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Manfred Hecking
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | | | - Friedrich K Port
- Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Urology, Medical School, University of Michigan, Ann Arbor, MI
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, Internal Medicine, Jikei University School of Medicine, Toyko, Japan
| | - Rita S Suri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montreal, Quebec, Canada
| | - Michel Jadoul
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Loreto Gesualdo
- Nephrology, Dialysis, and Transplantation, Department of Emergency Organ Transplantation, University of Bari Aldo Moro, Altamura, Italy
| | - Jeffrey Perl
- St. Michael's Hospital, Toronto, Ontario, Canada
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7
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Stenvinkel P. Obesity in Kidney Disease. ENDOCRINE DISORDERS IN KIDNEY DISEASE 2019:265-275. [DOI: 10.1007/978-3-319-97765-2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Bazyluk A, Malyszko J, Zbroch E. Cardiovascular risk in chronic kidney disease: what is new in the pathogenesis and treatment? Postgrad Med 2018; 130:461-469. [PMID: 29846140 DOI: 10.1080/00325481.2018.1481714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The prevalence of chronic kidney disease (CKD) has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular (CV) morbidity and mortality remain high among patients with CKD. Although CKD is a progressive and irreversible condition, it is possible to slow decreasing kidney function, as well as the development and progression of associated with kidney disease comorbidities. Diabetes mellitus has become major cause of CKD worldwide. It is estimated that the prevalence of diabetes will increase from 425 million worldwide in 2017 to 629 million by 2045, substantially the percentage of diabetic nephropathy among CKD patients is set to rise markedly. The results of multicenter trials concerning novel antidiabetic drugs suggest that efficacy in reducing CV risk is independent of the improvement in glycemic control. This review discusses underlying causes of high CV risk and strategies reducing individual burden among CKD patients.
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Affiliation(s)
- Angelika Bazyluk
- a 2-nd Department of Nephrology and Hypertension with Dialysis Centre , Medical University of Białystok , Bialystok , Poland
| | - Jolanta Malyszko
- a 2-nd Department of Nephrology and Hypertension with Dialysis Centre , Medical University of Białystok , Bialystok , Poland.,b JM- Department of Nephrology, Dialysis and Internal Medicine , Warsaw Medical University , Warsaw , Poland
| | - Edyta Zbroch
- a 2-nd Department of Nephrology and Hypertension with Dialysis Centre , Medical University of Białystok , Bialystok , Poland
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9
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Mokoli VM, Sumaili EK, Lepira FB, Mbutiwi FIN, Makulo JRR, Bukabau JB, Izeidi PP, Luse JL, Mukendi SK, Mashinda DK, Nseka NM. Factors associated with residual urine volume preservation in patients undergoing hemodialysis for end-stage kidney disease in Kinshasa. BMC Nephrol 2018; 19:68. [PMID: 29554877 PMCID: PMC5859481 DOI: 10.1186/s12882-018-0865-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa. METHODS This historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period. We compared the baseline characteristics of the patients according to their initial RUV (≤ 500 ml/day vs > 500 ml/day) using Student's t, Mann-Whitney U and Chi2 tests. Linear mixed-effects models were used to search for predictors of decreased RUV by adding potentially predictive baseline covariates of the evolution of RUV to the effect of time: age, sex, diabetes mellitus, hypertension, diastolic blood pressure, diuretics, angiotensin conversion enzyme inhibitors (ACEI), angiotensin receptor blockers, hypovolemia, chronic tubulointerstitial nephropathy, left ventricular hypertrophy and initial hemodialysis characteristic. A value of p < 0.05 was considered the threshold of statistical significance. RESULTS The majority of hemodialysis patients were male (68.8%, sex ratio 2.2), with a mean age of 52.5 ± 12.3 years. The population's RUV decreased with time, but with a slight deceleration. The mean RUV values were 680 ± 537 ml/day, 558 ± 442 ml/day and 499 ± 475 ml/day, respectively, at the initiation of HD and at 6 and 12 months later. The use of ACEI at the initiation of HD (beta coefficient 219.5, p < 0.001) and the presence of chronic tubulointerstitial nephropathy (beta coefficient 291.8, p = 0.007) were significantly associated with RUV preservation over time. In contrast, the presence of left ventricular hypertrophy at the initiation of HD was significantly associated with decreased RUV over time (beta coefficient - 133.9, p = 0.029). CONCLUSIONS Among incident hemodialysis patients, the use of ACEI, the presence of chronic tubulointerstitial nephropathy and reduced left ventricular hypertrophy are associated with greater RUV preservation in the first year of dialysis.
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Affiliation(s)
- Vieux Momeme Mokoli
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo. .,Hemodialysis Unit of Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo.
| | - Ernest Kiswaya Sumaili
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Jean Robert Rissassy Makulo
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Hemodialysis Unit of Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo
| | | | - Patrick Parmba Izeidi
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jeannine Losa Luse
- Hemodialysis Unit of Provincial General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Stéphane Kalambay Mukendi
- Hemodialysis Unit of Provincial General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Nazaire Mangani Nseka
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Hemodialysis Unit of Provincial General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
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10
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Brown A, Taheri S. Very-low-energy diets for weight loss in patients with kidney disease. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/jokc.2018.3.1.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Adrian Brown
- Researcher, Department of Diabetes, Endocrinology and Metabolism, Imperial College, London
| | - Shahrad Taheri
- Researcher, Department of Medicine and Clinical Research Core, Weill Cornell Medical College, New York
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11
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Yamany A, Shehata H, Essameldin M, Ibrahim S. Screening of incidental kidney disease in normoglycemic, normotensive healthy adults. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_35_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang AYM. Preserving Residual Kidney Function in Hemodialysis Patients-Back in the Spotlight. J Am Soc Nephrol 2016; 27:3504-3507. [PMID: 27493256 DOI: 10.1681/asn.2016060693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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Ha IS, Yap HK, Munarriz RL, Zambrano PH, Flynn JT, Bilge I, Szczepanska M, Lai WM, Antonio ZL, Gulati A, Hooman N, van Hoeck K, Higuita LMS, Verrina E, Klaus G, Fischbach M, Riyami MA, Sahpazova E, Sander A, Warady BA, Schaefer F. Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis. Kidney Int 2015; 88:605-13. [PMID: 25874598 PMCID: PMC4558567 DOI: 10.1038/ki.2015.108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 01/24/2015] [Accepted: 02/20/2015] [Indexed: 12/22/2022]
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.
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Affiliation(s)
- Il-Soo Ha
- Kidney Center for Children and Adolescents, Seoul National University Children's Hospital, Seoul, Korea
| | - Hui K Yap
- Shaw-NKF-NUH Children's Kidney Centre, The Children's Medical Institute, Singapore
| | | | | | | | - Ilmay Bilge
- Department of Pediatric Nephrology, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Maria Szczepanska
- Dialysis Division for Children, Department of Pediatrics, Zabrze Hospital, Zabrze, Poland
| | - Wai-Ming Lai
- Department of Paediatric & Adolescent Medicine, Princess Margaret, Hong Kong
| | - Zenaida L Antonio
- Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Ashima Gulati
- Department of Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Lina M S Higuita
- Baxter Servicio al Cliente Colombia, Medellin-Antioquia, Colombia
| | - Enrico Verrina
- Department of Pediatric Nephrology, Istituto Giannina Gaslini, Genova, Italy
| | | | - Michel Fischbach
- Children's Dialysis Center, Hopital de Hautepierre CHU, Strasbourg, France
| | | | | | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Franz Schaefer
- Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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14
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Vigotti FN, Teta L, Pia A, Mirasole S, Guzzo G, Giuffrida D, Capizzi I, Avagnina P, Ippolito D, Piccoli GB. Intensive weight loss combining flexible dialysis with a personalized, ad libitum, coach-assisted diet program. A "pilot" case series. Hemodial Int 2014; 19:368-78. [PMID: 25495862 DOI: 10.1111/hdi.12252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Obesity is a growing problem on dialysis. The best approach to weight loss has not been established. The risks of malnutrition may offset the advantages of weight loss. Personalized hemodialysis schedules, with an incremental approach, are gaining interest; to date, no studies have explored its potential in allowing weight loss. This case series reports on combining flexible, incremental hemodialysis, and intensive weight loss. SETTING a small Dialysis Unit, following incremental personalized schedules (2-6 sessions/week, depending on residual function), tailored to an equivalent renal clearance >12 mL/min. Four obese and two overweigh patients (5 male, 1 female; age: 40-63 years; body mass index [BMI] 31.1 kg/m(2)) were enrolled in a coach-assisted weight loss program, with an "ad libitum" approach (3-6 foods/day chosen on the basis of their glycemic index and glycemic load). The diet consists of 8 weeks of rapid weight loss followed by 8-12 weeks of maintenance; both phases can be repeated. This study measures weight loss, side effects, and patients' opinions. Over 12-30 months, all patients lost weight (median -10.3 kg [5.7-20], median ΔBMI-3.2). Serum albumin (pre-diet 3.78; post-diet 3.83 g/dL), hemoglobin (pre-diet 11; post-diet 11.2 g/dL), and acid-base balance (HCO(3) pre-diet: 23.3; post-diet: 23.4 mmol/L) remained stable, with decreasing needs for erythropoietin and citrate or bicarbonate supplements. Calcium-phosphate-parathyroid hormone (PTH) balance improved (PTH-pre 576; post 286 pg/mL). Three out of 4 hypertensive patients discontinued, 1 decreased antihypertensives. None experienced severe side effects. Patient satisfaction was high (9 on a 0-10 analog scale). Personalized, incremental hemodialysis schedules allow patient enrollment in intensive personalized weight loss programs, with promising results.
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Affiliation(s)
| | - Luigi Teta
- BLUE S.r.l., Bioimis Accademia Alimentare, Bassano del Grappa (VI), Italy
| | - Anna Pia
- SCDU Internal Medicine, University of Torino, Torino, Italy
| | - Sara Mirasole
- BLUE S.r.l., Bioimis Accademia Alimentare, Bassano del Grappa (VI), Italy
| | - Gabriella Guzzo
- SS Nephrology, SCDU Urology, University of Torino, Torino, Italy
| | - Domenica Giuffrida
- Obstetrics, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Irene Capizzi
- SSD Dietetics and Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Paolo Avagnina
- SSD Dietetics and Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Davide Ippolito
- BLUE S.r.l., Bioimis Accademia Alimentare, Bassano del Grappa (VI), Italy.,Laboratory of Physiology, Department of Biomedical Sciences, University of Padova, Padova, Italy
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Trimarchi H, Raña MS, Karl A, Andrews J, Dicugno M, Pomeranz V, Young P, Forrester M, Alonso M, Lombi F, Muryan A. Residual urinary output in high body mass index individuals on chronic hemodialysis: A disregarded life vest? World J Nephrol 2014; 3:317-323. [PMID: 25374828 PMCID: PMC4220367 DOI: 10.5527/wjn.v3.i4.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/12/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess residual diuresis and diverse variables according to body mass index (BMI).
METHODS: Cross-sectional study (n = 57), with 3 groups. Group A: BMI < 25, n = 22; Group B: BMI 25-30, n = 15; Group C: BMI > 30, n = 20. Diuresis, hematocrit, albumin, C-reactive protein, Malnutrition inflammatory score, Pro-BNP, Troponin T, leptin and insulin levels are expressed as median and ranges (r).
RESULTS: Albumin (g/dL): GA vs GC, 3.70 (r2.20-4.90) vs 3.85 (r3.40-4.90), P = 0.02. Diuresis (mL/d): GA 690 (r0-1780); GB 660 (r60-1800); GC 840 (r40-2840). Diuresis GA vs GC, P = 0.01. Leptin (ng/mL): GA vs GC, 3.81 (r0.78-69.60) vs GC, 32.80 (r0.78-124.50), P < 0.001. Insulin (µU/mL): GA vs GB, 7 (r2-44) vs 11.50 (r4-38), P = 0.02; GA vs GC, 7 (r2-44) vs 19.5 (r5-155), P = 0.0001. Troponin T and Pro-BNP levels were not different. Significant correlations: GC, Insulin-UF: ρ = 0.53; P = 0.03; TroponinT-diuresis: ρ = -0.48, P < 0.05; Pro-BNP-diuresis: ρ = -0.39, P < 0.01; Troponin T-ProBNP: ρ = 0.77, P < 0.0001; albumin-Troponin T: ρ = -0.66, P < 0.0001; albumin-ProBNP: ρ = -0.44, P < 0.05.
CONCLUSION: High BMI associated positively with higher diuresis and albuminemia, and negatively with TropT and Pro-BNP. High BMI-associated better survival may be explained by better urinary output, lowering cardiovascular stress.
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16
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Lu YH, Hwang JC, Jiang MY, Wang CT. Comparison of the impact of "fast decline" in residual renal function and "initial anuria" on long-term outcomes in CAPD patients. Perit Dial Int 2014; 35:172-9. [PMID: 24711636 DOI: 10.3747/pdi.2013.00060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/23/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of "initial anuria" and rapid RRFD on the long-term prognosis of CAPD patients. METHOD According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the "anuria" group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a "slow decliner" group (n = 114), and a "rapid decliner" group (n = 114). The maximal observation period was 120 months. RESULTS Logistic regression tests indicated that the "anuria" group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 - 23.28), and female (OR: 0.29, 95% CI: 0.09 - 0.90), while the "fast decliner" group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 - 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 - 1.21), and male (OR: 1.12; 95% CI: 1.04 - 1.21). After adjusting for DCS, the "fast decliner" group (hazard ratio [HR]: 0.37; 95% CI: 0.17 - 0.80) showed a better outcome than that of the "anuria" group (reference = 1). Both baseline RRF (β = -0.24; p < 0.001) and DCS (β = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 -.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 - 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 - 0.99) was significant for better survival in CAPD patients with DCS > 0. CONCLUSION Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.
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Affiliation(s)
- Yi-Hua Lu
- Division of Nephrology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jyh-Chang Hwang
- Division of Nephrology, Chi Mei Medical Center, Tainan, Taiwan Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ming-Yan Jiang
- Division of Nephrology, Chi Mei Medical Center, Tainan, Taiwan
| | - Charn-Ting Wang
- Division of Nephrology, Chi Mei Medical Center, Tainan, Taiwan
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Streja E, Nicholas SB, Norris KC. Controversies in timing of dialysis initiation and the role of race and demographics. Semin Dial 2013; 26:658-66. [PMID: 24102770 PMCID: PMC3836868 DOI: 10.1111/sdi.12130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dialysis remains the predominant form of renal replacement therapy in the United States, but the optimal timing for the initiation of dialysis remains poorly defined. Not only clinical factors such as signs/symptoms of uremia, co-existing cardiovascular disease, and presence of diabetes but also key demographic characteristics including age, gender, race/ethnicity, and socioeconomics have all been considered as potential modifying factors in the decision for the timing of dialysis initiation. The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of chronic kidney disease (CKD) suggests that dialysis be initiated when signs/symptoms attributable to kidney failure such as serositis, acid-base or electrolyte abnormalities, pruritus, poorly controlled volume status or blood pressure, deteriorating nutritional status despite dietary intervention, or cognitive impairment are visible or noted. These signs/symptoms typically occur when the glomerular filtration rate (GFR) is in the range of 5-10 ml/minute/1.73 m(2) , although they may occur at higher levels of GFR. We review recent data on the timing of dialysis initiation, their implications for managing patients with late-stage CKD, and the important role of considering key demographics in making patient-centered decisions for the timing of dialysis initiation.
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Affiliation(s)
- Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California
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18
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Stenvinkel P, Zoccali C, Ikizler TA. Obesity in CKD--what should nephrologists know? J Am Soc Nephrol 2013; 24:1727-36. [PMID: 24115475 DOI: 10.1681/asn.2013040330] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low- and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research.
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Affiliation(s)
- Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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19
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Stenvinkel P, Ikizler TA, Mallamaci F, Zoccali C. Obesity and nephrology: results of a knowledge and practice pattern survey. Nephrol Dial Transplant 2013; 28 Suppl 4:iv99-104. [PMID: 23737484 DOI: 10.1093/ndt/gft193] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity, the largest epidemic of modern time, carries a markedly increased risk of type-2 diabetes, cancer, fatty liver, sleep apnea, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. In addition, obesity increases the risk of chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD). There are limited data regarding the basic knowledge of nephrologists on how to assess and manage obesity in the setting of CKD. METHODS To learn more about practice patterns among nephrologists, a survey on obesity was published online in NDT-Educational between 8 November 2012 and 31 January 2013. Three-hundred and ninety-nine responses were received mostly from nephrologists in Europe (57%), South and Central America (12%) and the Middle East (10%). The majority practiced in clinical nephrology (64%) and outpatient dialysis clinics (23%). Whereas 54% of the participants worked in hospitals, 31% worked in academic centers. RESULTS Most participants stated that the number of obese patients has increased both among their CKD stage 2-5 patients and in their dialysis clinics during the last 10 years. For routine estimation of body fat content in the dialysis clinic, the majority of nephrologists (43%) still rely on the body mass index (BMI). A majority (72%) does not think that weight gain should be promoted in dialysis patients with a BMI of <35 kg/m(2). The survey also showed that 30% of the responders did not have any predetermined cut-off level for BMI. However, 29% used a cut-off level of 35 kg/m(2) and 27% used a cut-off level of 30 kg/m(2) for approval for kidney transplantation in their clinics. CONCLUSIONS The level of understanding of the intricacies of obesity in the setting of CKD needs improvement among nephrologists. Similarly, there is no consensus regarding weight management strategies in CKD patients with obesity. Studies are needed in this orphan area of renal research.
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Affiliation(s)
- Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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20
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Hoogeveen EK, Halbesma N, Rothman KJ, Stijnen T, van Dijk S, Dekker FW, Boeschoten EW, de Mutsert R. Obesity and mortality risk among younger dialysis patients. Clin J Am Soc Nephrol 2012; 7:280-8. [PMID: 22223612 DOI: 10.2215/cjn.05700611] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Many studies show that obesity in dialysis patients is not strongly associated with mortality but not whether this modest association is constant over age. This study investigated the extent to which the relation of body mass index (BMI) and mortality differs between younger and older dialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Adult dialysis patients were prospectively followed from their first dialysis treatment for 7 years or until death or transplantation. Patients were stratified by age (<65 or ≥65 years) and baseline BMI (<20, 20-24 [reference], 25-29, and ≥30 kg/m(2)). RESULTS The study sample included 984 patients younger than 65 years and 765 patients 65 years or older; cumulative survival proportions at end of follow-up were 50% and 16%. Age-standardized mortality rate was 1.7 times higher in obese younger patients than those with normal BMI, corresponding to an excess rate of 5.2 deaths/100 patient-years. Mortality rates were almost equal between obese older patients and those with normal BMI. Excess rates of younger and older patients with low compared with normal BMI were 8.7 and 1.1 deaths/100 patient-years. After adjustment for age, sex, smoking, comorbidity, and treatment modality, hazard ratios by increasing BMI were 2.00, 1, 0.95, and 1.57 for younger patients and 1.07, 1, 0.88, and 0.91 for older patients, implying that obesity is a 1.7-fold (95% confidence interval, 1.1- to 2.9-fold) stronger risk factor in younger than older patients. CONCLUSIONS In contrast to older dialysis patients, younger patients with low or very high BMI had a substantially elevated risk for death.
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Affiliation(s)
- Ellen K Hoogeveen
- Department of Internal Medicine and Nephrology, Jeroen Bosch Hospital, Postbox 90153, 5200 ME, 's-Hertogenbosch, The Netherlands.
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Kjaergaard KD, Jensen JD, Peters CD, Jespersen B. Preserving residual renal function in dialysis patients: an update on evidence to assist clinical decision making. NDT Plus 2011; 4:225-30. [PMID: 25949486 PMCID: PMC4421450 DOI: 10.1093/ndtplus/sfr035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/28/2011] [Indexed: 12/29/2022] Open
Abstract
It has been documented that preservation of residual renal function in dialysis patients improves quality of life as well as survival. Clinical trials on strategies to preserve residual renal function are clearly lacking. While waiting for more results from clinical trials, patients will benefit from clinicians being aware of available knowledge. The aim of this review was to offer an update on current evidence assisting doctors in clinical practice.
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Affiliation(s)
- Krista Dybtved Kjaergaard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Jens Dam Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Christian Daugaard Peters
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Sherman RA. Briefly noted: Renal transplantation. Semin Dial 2009; 22:707-8. [PMID: 20017845 DOI: 10.1111/j.1525-139x.2009.00653.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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