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NDT Advance Access originally published online on February 24, 2009
Nephrology Dialysis Transplantation 2009 24(8):2502-2510; doi:10.1093/ndt/gfp071
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose

Enric Vilar1, David Wellsted2, Shahid M. Chandna1, Roger N. Greenwood1 and Ken Farrington1

1 Renal Unit, Lister Hospital, Stevenage 2 Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, UK

Correspondence and offprint requests to: Enric Vilar; E-mail: evilar{at}doctors.org.uk



  Abstract

Background and Methods. The importance of residual renal function is well recognized in peritoneal dialysis but its role in haemodialysis (HD) has received much less attention. We studied 650 incident patients in our incremental high-flux HD programme over a 15-year period. Target total Kt/V urea (dialysis plus residual renal) was 1.2 per session and monitored monthly. Renal urea clearance (KRU) was estimated 1–3 monthly.

Results. KRU declined during the first 5 years of HD from 3.1 ± 1.9 at 3 months to 0.9 ± 1.2 ml/min/1.73 m2 at 5 years. The percentage of patients with KRU ≥ 1 ml/min at these time points was 85% and 31%, respectively. Patients with KRU ≥ 1 ml/min had a significantly lower mean creatinine (all time points), ultrafiltration requirement (all time points) and serum potassium (6, 12, 36 and 48 months). Nutritional parameters were also significantly better in respect to nPCR and serum albumin (6, 12, 24 and 36 months). Patients with KRU ≥ 1 ml/min had significantly lower erythropoietin requirements and erythropoietin resistance indices (12, 24, 36 and 48 months).

 Mortality was significantly lower in patients with a KRU ≥ 1 at 6, 12 and 24 months after HD initiation, this benefit being maintained after correcting for albumin, age, comorbidities, HDF use and renal diagnosis. Our unique finding was that these benefits occurred despite those with KRU ≥ 1 ml/min having a significantly lower dialysis Kt/V at all time points.

Conclusion. The associations demonstrated suggest that residual renal function contributes significantly to outcome in HD patients and that efforts to preserve it are warranted. Comparative outcome studies should be controlled for residual renal function.

Keywords: haemodialysis; haemodialysis adequacy; mortality; outcomes; survival

Received for publication: 4.11.08
Accepted in revised form: 3. 2.09


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