Clinical profiles and outcomes of end-stage renal failure patients with late initiation of renal replacement therapy based on uremic symptoms under intensive renoprotective therapies.
OBJECTIVE
This study describes the clinical profiles and outcomes of renal failure patients with late initiation of renal replacement therapies (RRT) based on uremic symptoms under intensive treatment prior to the start of RRT (IT).


METHODS
Thirteen patients (male 10, female 3) with end-stage renal disease who preferred to wait for the initiation of RRT until uremic symptoms appeared regardless of serum creatinine (s-Cr) and 24-hour creatinine clearance (24-hour Ccr) were chosen. All patients received IT including a low-protein diet, antihypertensive drugs including enalapril, erythropoietin and others to prevent and manage uremic states until the initiation of RRT. Clinical findings at the initiation of RRT and the outcomes after the start of RRT were examined.


RESULTS
RRT was initiated 23.6 +/- 16.9 months after IT without any complication in all patients when mild uremic symptoms appeared. Uremic symptoms, blood pressure, serum albumin, potassium, calcium and urinary Cr excretion were well controlled except inorganic phosphate, hemoglobin and cardiac size. 24-hour Ccr and s-Cr were 3.4 +/- 0.7 ml/min and 17.4 +/- 3.8 mg/dl at initiation of RRT. The outcomes of all the patients were all well during chronic RRT.


CONCLUSIONS
Intensive treatment prior to the start of RRT can diminish uremic symptoms and complications so that RRT might be initiated safely and with fewer problems, even in the face of lower 24-hour Ccr and markedly higher s-Cr.
Kaizu
Kazo
K
Kidney Center, University of Occupational and Environmental Health (UOEH), Nakama, Japan. k-kaizu@clnc.uoeh-u.ac.jp
Uriu
Kohei
K
Inada
Yoshifumi
Y
Hashimoto
Osamu
O
Mizobe
Takamitsu
T
Takagi
Iichiro
I
Ito
Aki
A
Suzuka
Kanako
K
Qie
Yue Ling
YL
Lee
Wei
W
Miyamoto
Hidemitsu
H
Tanaka
Yoshiya
Y
D000959:Antihypertensive Agents; D001794:Blood Pressure / Q000502:physiology; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood / Q000652:urine; D018753:Diet, Protein-Restricted; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D011188:Potassium / Q000097:blood; D017582:Renal Replacement Therapy; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome; D014511:Uremia / Q000209:etiology*
D000959:Antihypertensive Agents; D012709:Serum Albumin; D003404:Creatinine; D011188:Potassium; D002118:Calcium