title: Preservation of residual renal function by not removing water in new hemodialysis patients: a randomized, controlled study.
abstract: OBJECTIVE
  To investigate the effect of no water removal (NWR) on preservation of residual renal function (RRF) in new hemodialysis (HD) patients.
  
  
  METHODS
  Fifty-six patients with a daily urine volume ≥ 1,000 mL were included. Patients were randomized to different fluid management groups of NWR or water removal (WR) for 6 months. If predialysis BP was >150/90 mmHg, patients could take antihypertensive drugs. The primary endpoints included death, cardio-cerebral vascular disease, refractory hypertension, and edema or an auxiliary examination indicating obvious fluid retention. The secondary endpoint was oliguria. A daily urine volume, 24-h urine creatinine clearance, the defined daily dose (DDD) index of antihypertensive drugs, erythropoietin resistance index, cardiothoracic ratio, and left ventricular mass index (LVMI) were recorded.
  
  
  RESULTS
  Eight patients in the NWR group reached the primary endpoints. Nine patients in the WR group reached the secondary endpoint. At the end of the study, patients in the NWR group had more increased systemic blood pressure (9.0 ± 8.3 vs. -2.4 ± 2.0 mmHg, p < 0.001), DDD index (1.2 ± 1.02 vs. -0.9 ± 0.51, p < 0.001), daily urine volume (164 ± 351 vs. -726 ± 342 mL, p < 0.001), cardiothoracic ratio (0.02 ± 0.04 vs. -0.03 ± 0.03, p < 0.001), LVMI (9.6 ± 17.0 vs. -12.0 ± 21.4 g/m(2), p < 0.001), and less decreased urine creatinine clearance (-1.0 ± 0.4 vs. -2.0 ± 1.0, p < 0.001), compared with those patients in the WR group.
  
  
  CONCLUSIONS
  Preservation of RRF by NWR is warranted in new HD patients, but is not appropriate for all patients.
authors.affiliation: Department of Nephrology, Affiliated Beijing Friendship Hospital, Faculty of Kidney Diseases, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
authors.forename: Sha
authors.initials: S
authors.lastname: Liu
authors.forename: Zongli
authors.initials: Z
authors.lastname: Diao
authors.forename: Dongliang
authors.initials: D
authors.lastname: Zhang
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Ding
authors.forename: Wenying
authors.initials: W
authors.lastname: Cui
authors.forename: Wenhu
authors.initials: W
authors.lastname: Liu
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood / Q000652:urine; D004487:Edema / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000209:etiology / Q000652:urine; D018579:Patient Selection; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D020257:Ventricular Remodeling; D014867:Water / Q000378:metabolism*
chemical_list: D014867:Water; D003404:Creatinine