title: 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.
abstract: 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.
authors.affiliation: Kidney Center, University of Occupational and Environmental Health (UOEH), Nakama, Japan. k-kaizu@clnc.uoeh-u.ac.jp
authors.forename: Kazo
authors.initials: K
authors.lastname: Kaizu
authors.forename: Kohei
authors.initials: K
authors.lastname: Uriu
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Inada
authors.forename: Osamu
authors.initials: O
authors.lastname: Hashimoto
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Mizobe
authors.forename: Iichiro
authors.initials: I
authors.lastname: Takagi
authors.forename: Aki
authors.initials: A
authors.lastname: Ito
authors.forename: Kanako
authors.initials: K
authors.lastname: Suzuka
authors.forename: Yue Ling
authors.initials: YL
authors.lastname: Qie
authors.forename: Wei
authors.initials: W
authors.lastname: Lee
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: 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*
chemical_list: D000959:Antihypertensive Agents; D012709:Serum Albumin; D003404:Creatinine; D011188:Potassium; D002118:Calcium