Predictors of faster decline of residual renal function in Taiwanese peritoneal dialysis patients.
OBJECTIVE
Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan.


METHODS
The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann-Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors (p < 0.05) for faster decline of residual GFR.


RESULTS
All patients commencing PD during the study period were followed for 39.4 +/- 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 +/- 1.47 mL/min/m(2). On multivariate analysis, presence of diabetes mellitus (p < 0.001), higher baseline residual GFR (p < 0.001), hypotensive events (p = 0.001), use of diuretics (p = 0.002), and episodes of peritonitis (p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis.


CONCLUSIONS
Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chia-Te
CT
Liao
Chih-Chung
CC
Shiao
Jenq-Wen
JW
Huang
Kuan-Yu
KY
Hung
Hsueh-Fang
HF
Chuang
Yung-Ming
YM
Chen
Kwan-Dun
KD
Wu
Tun-Jun
TJ
Tsai
D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D007677:Kidney Function Tests; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D010538:Peritonitis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014508:Urea / Q000097:blood
D004232:Diuretics; D014508:Urea; D003404:Creatinine