HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Ethier I, Cho YJ, Hawley C, et al.

Rate of Decline in Residual Kidney Function Before and After Peritoneal Dialysis Initiation: A Post Hoc Analysis of the IDEAL Study

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:50A 2020


Residual kidney function (RKF) is associated with improved survival and quality of life in dialysis patients. Previous studies have suggested that commencement of peritoneal dialysis (PD) may slow RKF decline compared to the pre-dialysis period. We sought to evaluate the association between PD initiation and RKF decline in the Initiating Dialysis Early And Late (IDEAL) trial.


In this post hoc analysis of the IDEAL randomized controlled trial, PD participants were included if results from 24-hour urine collections had been recorded within 30 days of dialysis initiation (-30 to +30 days from start), and at least one value pre- and one value post-dialysis commencement were available. The primary outcome was slope of RKF decline, calculated as mean of urinary creatinine and urea clearances. Secondary outcomes included slope of urine volume decline and time from PD initiation to anuria.


The study included 151 participants (79 early- start group, 72 late-start group). The slope of RKF decline was slower after PD commencement (-2.69±0.18 mL/min/1.73m2/yr) compared to before PD commencement (-4.09±0.33 mL/min/1.73m2/yr; change in slope +1.19 mL/min/1.73m2/yr, 95% CI 0.48-1.90, p<0.001). In contrast, urine volume decline was faster after PD commencement (- 0.74±0.05 L/yr) compared to beforehand (-0.57±0.06 L/yr; change in slope -0.18 L/yr, 95%CI -0.34—-0.01, p=0.04). No differences were observed between the early- and late-start groups with respect to RKF decline, urine volume decline or time to anuria.


Commencement of PD was associated with a slower decline of RKF compared to the pre-dialysis period.


Figure 1. Trend of glomerular filtration rate (normalized to BSA) over time. Gray lines: individual patient measurements; black lines: predicted slopes in the pre- and post-dialysis initiation periods.

c Copyright 2020 -2021 American Society of Nephrology. Reproduced with permission.
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