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Evaluation Studies |
Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia. david_johnson@health.qld.gov.au
OBJECTIVE: The aim of this study was to prospectively evaluate the risk factors for decline of residual renal function (RRF) in an incident peritoneal dialysis (PD) population. DESIGN: Prospective observational study of an incident PD cohort at a single center. SETTING: Tertiary-care institutional dialysis center. PARTICIPANTS: The study included 146 consecutive patients commencing PD at the Princess Alexandra Hospital between 1 August 1995 and 1 July 2001 (mean age 54.8 +/- 1.4 years, 42% male, 34% diabetic). Patients with failed renal transplants (n = 26) were excluded. MAIN MEASUREMENTS: Timed urine collections (n = 642) were performed initially and at 6-month intervals thereafter to measure RRF. The development of anuria was also prospectively recorded. RESULTS: The mean (+/- SD) follow-up period was 20.5 +/- 14.8 months. The median slope of RRF decline was -0.05 mL/minute/month/1.73 m2. Using binary logistic regression, it was shown that the 50% of patients with more rapid RRF loss (< -0.05 mL/min/month/1.73 m2) were more likely to have had a higher initial RRF at commencement of PD [adjusted odds ratio (AOR) 1.83, 95% confidence interval (CI) 1.39-2.40] and a higher baseline dialysate/ plasma creatinine ratio at 4 hours (D/P creat; AOR 44.6, 95% CI 1.05-1900). On multivariate Cox proportional hazards model analysis, time from commencement of PD to development of anuria was independently predicted by baseline RRF [adjusted hazard ratio (HR) 0.81, 95% CI 0.60-0.81], D/P creat (HR 2.87, 95% CI 2.06-82.3), body surface area (HR 6.23, 95% CI 1.53-25.5), dietary protein intake (HR 2.87, 95% CI 1.06-7.78), and diabetes mellitus (HR 1.65, 95% CI 1.00-2.72). Decline of RRF was independent of age, gender, dialysis modality, urgency of initiation of dialysis, smoking, vascular disease, blood pressure, medications (including angiotensin-converting enzyme inhibitors), duration of follow-up, and peritonitis rate. CONCLUSIONS:The results of this study suggest that high baseline RRF and high D/P creat ratio are risk factors for rapid loss of RRF. Moreover, a shorter time to the onset of anuria is independently predicted by low baseline RRF, increased body surface area, high dietary protein intake, and diabetes mellitus. Such at-risk patients should be closely monitored for early signs of inadequate dialysis.
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