Risk Factors Influencing Decline of Residual Renal Function

Korean Journal of Nephrology 2010;29(6):752-760.

Gun-Hyun Kim, M.D., Seung-Hyea Hyun, M.D., Hye-Jin Seo, M.D., Ji-Young Choi, M.D., Ji-Hyung Cho, M.D., Chan-Duck Kim, M.D., Sun-Hee Park, M.D. and Yong-Lim Kim,

Division of Nephrology, Department of Internal Medicine, Kyungpook National University, School of Medicine and Clinical Research Center for ESRD, Daegu, Korea

원저 : 지속외래복막투석 환자에서 잔여신기능의 감소에 영향을 미치는 인자

김건현, 현승혜, 서혜진, 최지영, 조지형, 김찬덕, 박선희, 김용림

경북대학교 의학전문대학원 내과학교실, 말기심부전 임상연구센터

Abstract

Purpose: Preservation of residual renal function (RRF) after initiation of peritoneal dialysis (PD) is beneficial for patient survival. It is unclear that same risk factors of pre-dialysis chronic kidney disease (CKD) patients affect RRF in PD patients. This study was aimed to evaluate factors affecting RRF after commencement of PD. Methods: Data from 80 patients commencing CAPD at Kyungpook National University Hospital between January 2001 and December 2008 were retrospectively collected. After PD commencement, biochemical and clinical data at baseline (1 month), 6, and 12 month were obtained. RRF was calculated as the average of creatinine clearance and urea nitrogen clearance from 24-hour urine collection and normalized with body surface area and mean RRF decline rate was calculated by dividing RRF difference between baseline to 12 month by period. Results: Mean RRF decline rate (mL/min/1.73m2/month) was negatively correlated with left ventricular posterior wall thickness (LVPWT) (R2=0.097, p=0.023) and proteinuria (R2=0.126, p=0.003), whereas positively correlated with hematocrit (R2=0.076, p=0.013) at baseline. Comparison between the two groups divided by median RRF decline rate (-0.082 mL/min/1.73m2/month) showed that baseline proteinuria (p<0.001), the number of antihypertensive agents (p=0.030) and LVPWT (p=0.039) were higher in the decline group. In addition, the number of antihypertensive agents was higher in the decline group at 1 year, although there was no difference of blood pressure between the two groups. Using multiple binary logistic regression, it was shown that more rapid RRF decline (<-0.082 mL/min/1.73m2/month) was likely to have higher proteinuria [adjusted odd ratio (AOR) 3.310, 95% confidence interval (CI) 1.363-8.041], and thicker LVPWT [AOR 1.682, 95% CI 1.043-2.711] at baseline. Conclusion: Decline of RRF during a year after commencement of PD was associated with baseline proteinuria and LVPWT.

Key Words: Continuous ambulatory peritoneal dialysis, Proteinuria, Left ventricular hypertrophy