Preservation of residual kidney function in hemodialysis patients

[Zach]

Preservation of residual kidney function in hemodialysis patients: reviving an old concept

Kidney International
August 2016
Volume 90, Issue 2, Pages 262–271

Anna T. Mathew¹, Steven Fishbane¹, Yoshitsugu Obi² and Kamyar Kalantar-Zadeh<sup>2,3,4

1</sup>Hofstra Northwell School of Medicine, Division of Kidney Diseases and Hypertension, Northwell Health, Great Neck, New York, USA; ²Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA; ³Fielding School of Public Health at UCLA, Los Angeles, California, USA; and ⁴Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA

Residual kidney function (RKF) may confer a variety of benefits to patients on maintenance dialysis. RKF provides continuous clearance of middle molecules and protein-bound solutes. Whereas the definition of RKF varies across studies, interdialytic urine volume may emerge as a pragmatic alternative to more cumbersome calculations. RKF preservation is associated with better patient outcomes including survival and quality of life and is a clinical parameter and research focus in peritoneal dialysis.

We propose the following practical considerations to preserve RKF, especially in newly transitioned (incident) hemodialysis patients: (1) periodic monitoring of RKF in hemodialysis patients through urine volume and including residual urea clearance with dialysis adequacy and outcome markers such as anemia, fluid gains, minerals and electrolytes, nutritional, status and quality of life; (2) avoidance of nephrotoxic agents such as radiocontrast dye, nonsteroidal anti-inflammatory drugs, and aminoglycosides; (3) more rigorous hypertension control and minimizing intradialytic hypotensive episodes; (4) individualizing the initial dialysis prescription with consideration of an incremental/infrequent approach to hemodialysis initiation (e.g., twice weekly) or peritoneal dialysis; and (5) considering a lower protein diet, especially on nondialysis days. Because RKF appears to be associated with better patient outcomes, it requires more clinical and research focus in the care of hemodialysis and peritoneal dialysis patients.

Article Outline
The importance of RKF
Predictors of loss of RKF
Measurement of RKF
Use of RKF to guide incremental dialysis dosing
Considerations to preserve RKF in HDs patients
Conclusions
Disclosure
References

For the complete article:
http://www.kidney-international.org/article/S0085-2538(16)30054-0/fulltext

[kristina]

Many thanks Zach for this very encouraging article !
I found this article most interesting because I am very grateful for my residual kidney function. Despite dialysis I have never stopped with my kidney- friendly & kidney-function-encouraging-vegetarian-diet and I still drink every day half a glass of fresh lime-juice (=inspires the kidneys to function a little longer) ... and hopefully my residual kidney-function continues until the telephone rings for that particular call...
Many thanks again Zach for this encouraging article from Kristina.