MP601RESIDUAL RENAL FUNCTION IN PATIENTS TREATED WITH CHRONIC HEMODIALYSIS

Abstract

Introduction and Aims: Outcome studies suggest that residual renal function (RRF) is a more important determinant of patient survival, morbidity, and quality of life than the prescribed or achieved dialysis dose. Majority of patients treated by hemodialysis loose RRF more rapidly than those on peritoneal dialysis (PD). Even though the importance of maintains of RRF has been emphasized in PD patients, and less attention has been given to RRF in hemodialysis (HD) patients. The aim of this analysis was to investigate which clinical and laboratory parameters are associated with residual diuresis. Methods: We analyzed 206 (120 male) chronic HD patients mean age 67.8±13.2. The mean duration of renal replacement therapy (RRT) was 56.6±66.4 months. In the primary analysis we were interested to explore the relationship between daily diuresis and various demographic and clinical parameters (age, gender, duration of HD, co-morbid conditions, cardiothoracic index and the presence of peripheral edema) as well as between daily diuresis and various dialytic parameters; dry weight, use of high or low flux membrane, weekly intradialytic weight gain, hypotensive episodes, systolic blood pressure (SBP) before HD, SBP after HD, diastolic blood pressure (DBP) before HD and DBP after HD. Also, we analyzed the association between daily diuresis and various laboratory parameters ( potassium, sodium, creatinine, bun, CRP, serum albumins, hemoglobin), as well as the association between daily diuresis and prescribed therapy; ACE inhibitors (ACE-I)/angiotensin receptor blockers (ARB), calcium channel blockers (CCB), use of diuretics and dose of diuretics, central antihypertensive, beta blockers (BB), EPO use and statin use. In the second analysis we were interested to analyze what is the association among the etiology of chronic kidney disease and RRF. Results: We didn't find any significant correlation among residual diuresis and age, gender, presence of hypertension and coronary heart disease (p=NS). Among investigated laboratory tests only serum potassium (r= -0.143; p=0.05) and serum creatinine (r= 0.181; p=0.01) have shown significant correlation with residual diuresis. Additionally, duration of HD (r= -0.339;p<0.0001), presence of diabetes (-0.173; p=0.02), weekly intradialytic weight gain (r= -0.185;p=0.01) and hypotensive episodes during HD procedures (r= -0.188; p=0.009) showed significant negative correlation with residual diuresis. On the other hand, cardiothoracic index (r=0.217; p=0.01), diuretics use (r=0.326;p<0.0001), daily diuretic dose (r=0.276;p=0.0001), use of ACE-I/ ARBs (r=0.148; p=0.04) and calcium channel blockers (CCB) (r=0.152; p=0.03) as well as systolic blood pressure (SBP) before (r=0.148; p=0.04) and after HD (r=0.263; p=0.0002) as well as diastolic blood pressure (DBP) before the start of HD treatment (r=0.149;p=0.04) and DBP after HD procedures (r=0.244;p=0.0007) have shown significant positive correlation with residual diuresis. Patients with chronic nephritis had the longest duration of HD treatment. In comparison to the patients with diabetic nephropathy who had the shortest duration of HD treatment, patients with chronic nephritis had relatively preserved RRF Conclusions: Use of diuretics, ACE-I/ARBs and CCB and weekly intradialytic weight gain, as well as SBP and DBP before the HD, and especially SBP and DBP after the start of dialysis treatment were significantly associated with preserved renal function.