The importance of residual renal function for survival in patients on peritoneal dialysis.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:185A 1997
The association between residual renal function and long-term outcome in peritoneal dialysis is investigated. The CANUSA cohort prospective study demonstrated that there is an association between adequacy indices considered as time-dependent covariates and patient outcome, but the change in these indices during follow-up was mainly due to progressive reduction in residual renal function.
These considerations have led the authors to re-analyse the CANUSA database to evaluate the contribution of residual renal function to patient survival. The glomerular filtration rate (GFR) was estimated from the mean of creatinine and urea 24h clearances measured every 6 months. Patients have been divided into two groups according to their baseline GFR above or below the overall mean. The above-mean group showed a significantly better survival at 24 months than the other group, but baseline GFR failed to predict survival for more than 24 months. Applying Cox multivariate analysis of relative risk (RR), each 5 L/week GFR increase considered as time-dependent covariate was associated to 10% reduction in RR of death (RR 0.908, 95% CI from 0.858 to 0.960). The effect of GFR on patient survival was as important as serum albumin levels.
Comment: This study is a further demonstration of the importance of residual renal function in peritoneal dialysis adequacy. There is a spontaneous and progressive reduction in GFR as a consequence of chronic nephropathy, but it is possible to favour its preservation avoiding nephrotoxicity and dehydration. This study also supports the anticipation of peritoneal dialysis treatment as recommended in NKF-DOQI guidelines. (Gianpaolo Amici, M.D., Treviso, Italy)
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ASN 30th Annual Meeting, San Antonio
Basic peritoneal dialysis : Chronic PD regimens, adequacy, modeling
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