Abstract
Little data are available regarding the course of residual renal function (RRF) and the predictors of RRF loss in hemodialysis (HD) patients. We evaluated the decline of RRF after the initiation of HD and the related clinical variables in 25 maintenance HD patients (male 17, female 8 ; age, 68±12 years ; observational period, 41±19 months). The incidences of RRF loss defined by urinary volume (UV) of less than 200 mL/day were 12.9% at 2 years, 40.7% at 3 years, and 88.6% at 5 years. A multivariate regression model showed that the rate of change in dry weight during 24 months after the initiation of HD was significantly associated with changes in UV (β=0.54, p=0.005, R2=0.70) and changes in estimated glomerular filtration rate defined by the average values of creatinine clearance and urea clearance (β=0.54, p=0.06, R2=0.39), respectively. Cox proportional hazard model showed that urinary protein excretion, the rate of change in dry weight during 24 months after the initiation of HD, and the initial UV were factors independently associated with RRF loss (hazard ratio, 3.30 (95%CI, 1.46-7.46), 0.84 (0.71-0.99), 0.995 (0.991-0.999), p=0.004, 0.04, 0.007). In conclusion, proteinuria, the change in dry weight, and initial urinary volume were significantly associated with RRF loss in maintenance HD patients. Additional studies regarding the influence of volume status and nutritional status on RRF loss in maintenance HD patients are necessary.
