HDCN Abstract:  Am Soc Nephrol Ann Mtg -- Toronto  

Park JA, Kim DJ, Chung S, Han HJ, Huh W, et al

The effect of hemodialysis during break-in on residual renal function in CAPD patients

Am Soc Nephrol Ann Mtg -- Toronto
J Am Soc Nephrol (Sep) 11:215A 2000

During break-in period some patients need hemodialysis(HD) or other intermittent dialysis. In such cases residual renal function(RRF) can decrease substantially compared with patients who do not need HD during break-in period since RRF is preserved better in CAPD patients than HD patients.

This is prospective observational study to examine such an effect of HD during break-in period on residual renal function in CAPD patients.

20 patients who were clinically stable and had been on CAPD since March, 1999 were observed. 6 patients were treated with HD for 1 month during break-in period and CAPD thereafter(group A). 14 patients were treated with CAPD without HD (group B). GFR(mean of creatinine and urea clearance of urine) and urine Kt/V urea(u-Kt/V) were measured at start, and 1, 3, 6 months of renal replacement therapy. Covariables analyzed in this study were mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, the presence of diabetes mellitus, and peritonitis episode.

There was no significant difference in initial RRF, mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, the presence of diabetes mellitus, and peritonitis episode between 2 groups. Initial GFR was little smaller in group A than group B ( 45.0 ±10.1 vs. 54.6 ±5.7) which was not statistically significant. GFR after 1,3 and 6months of dialysis ( including 1month of HD in group A) were smaller in group A than group B ( 28.6 ±5.3 vs. 54.4 ±5.7, 32.7 ±5.2 vs. 56.9 ±6.1, 21.0 ±4.1 vs. 53.6±5.4 at 1,3,6 months after dialysis in group A and B), which were significant.

The change of GFR, u-Kt/V had no correlation with serum albumin, hemoglobin, hematocrit, and change of mean arterial blood pressure and was not affected by sex, and the presence of DM or peritonitis.

We conclude that HD in break-in period can decrease RRF in CAPD patients which does not recover after 6 months of dialysis. Early start of CAPD without break-in period when dialysis is needed just after catheter insertion, should be considered to preserve RRF.

Copyright 2000, American Society of Nephrology. Reproduced with permission