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THE JOHN F. MAHER AWARD RECIPIENT LECTURES 2006 |
University Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
Correspondence to: A.Y.-M. Wang, University Department of Medicine, Queen Mary
Hospital, University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong,
China.
aymwang{at}hku.hk
The CANUSA study originally reported the importance of total small-solute
clearance in predicting survival of peritoneal dialysis (PD) patients.
However, subsequent reanalysis of data from the CANUSA study clearly
demonstrated that the predictive power for mortality in PD patients was
largely attributable to residual renal function (RRF) and not to the dose of
PD. While this should not lead to the assumption that the dose of PD is
unimportant, it does clearly indicate that the contribution of residual renal
clearance and PD clearance to the overall survival of PD cannot be considered
equivalent. In a previous study, we also demonstrated the importance of loss
of RRF in predicting a heightened risk of mortality and cardiovascular death
in PD patients. In this review, we focus our discussion on the different
potential mechanisms that explain the important link between RRF and
cardiovascular disease and survival of PD patients. We provide evidence to
explain why RRF is so important to patients receiving long-term PD treatment
and why it should be regarded as the "heart" of PD.
KEY WORDS: KEY WORDS:; Residual renal function; cardiovascular; nutrition; inflammation.
Received 15 December 2006; accepted 3 January 2007.
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