title: Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis.
abstract: In dialyzed patients, preservation of residual renal function is associated with better survival, lower morbidity, and greater quality of life. To analyze the evolution of residual diuresis over time, we prospectively monitored urine output in 401 pediatric patients in the global IPPN registry who commenced peritoneal dialysis (PD) with significant residual renal function. Associations of patient characteristics and time-variant covariates with daily urine output and the risk of developing oligoanuria (under 100 ml/m(2)/day) were analyzed by mixed linear modeling and Cox regression analysis including time-varying covariates. With an average loss of daily urine volume of 130 ml/m(2) per year, median time to oligoanuria was 48 months. Residual diuresis significantly subsided more rapidly in children with glomerulopathies, lower diuresis at start of PD, high ultrafiltration volume, and icodextrin use. Administration of diuretics significantly reduced oligoanuria risk, whereas the prescription of renin-angiotensin system antagonists significantly increased the risk oligoanuria. Urine output on PD was significantly associated in a negative manner with glomerulopathies (-584 ml/m(2)) and marginally with the use of icodextrin (-179 ml/m(2)) but positively associated with the use of biocompatible PD fluid (+111 ml/m(2)). Children in both Asia and North America had consistently lower urine output compared with those in Europe perhaps due to regional variances in therapy. Thus, in children undergoing PD, residual renal function depends strongly on the cause of underlying kidney disease and may be modifiable by diuretic therapy, peritoneal ultrafiltration, and choice of PD fluid.
authors: Kidney Center for Children and Adolescents, Seoul National University Children's Hospital, Seoul, Korea.
authors: Il-Soo
authors: IS
authors: Ha
authors: Shaw-NKF-NUH Children's Kidney Centre, The Children's Medical Institute, Singapore.
authors: Hui K
authors: HK
authors: Yap
authors: Cayetano Heredia Hospital, Lima, Peru.
authors: Reyner L
authors: RL
authors: Munarriz
authors: Hospital Dr Exequiel Gonzalez Cortes, Santiago de Chile.
authors: Pedro H
authors: PH
authors: Zambrano
authors: Seattle Children's Hospital, Seattle, WA, USA.
authors: Joseph T
authors: JT
authors: Flynn
authors: Department of Pediatric Nephrology, Istanbul University Medical Faculty, Istanbul, Turkey.
authors: Ilmay
authors: I
authors: Bilge
authors: Dialysis Division for Children, Department of Pediatrics, Zabrze Hospital, Zabrze, Poland.
authors: Maria
authors: M
authors: Szczepanska
authors: Department of Paediatric & Adolescent Medicine, Princess Margaret, Hong Kong.
authors: Wai-Ming
authors: WM
authors: Lai
authors: Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines.
authors: Zenaida L
authors: ZL
authors: Antonio
authors: Department of Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors: Ashima
authors: A
authors: Gulati
authors: Iran University of Medical Sciences, Tehran, Iran.
authors: Nakysa
authors: N
authors: Hooman
authors: University Hospital Antwerp, Edegem, Belgium.
authors: Koen
authors: K
authors: van Hoeck
authors: Baxter Servicio al Cliente Colombia, Medellin-Antioquia, Colombia.
authors: Lina M S
authors: LM
authors: Higuita
authors: Department of Pediatric Nephrology, Istituto Giannina Gaslini, Genova, Italy.
authors: Enrico
authors: E
authors: Verrina
authors: KfH Pediatric Kidney Center, Marburg, Germany.
authors: Günter
authors: G
authors: Klaus
authors: Children's Dialysis Center, Hopital de Hautepierre CHU, Strasbourg, France.
authors: Michel
authors: M
authors: Fischbach
authors: Department of Child Health, Royal Hospital, Muscat, Oman.
authors: Mohammed A
authors: MA
authors: Riyami
authors: Pediatric Clinic, Nephrology Unit, Skopje, Macedonia.
authors: Emilja
authors: E
authors: Sahpazova
authors: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors: Anja
authors: A
authors: Sander
authors: Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Bradley A
authors: BA
authors: Warady
authors: Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
authors: Franz
authors: F
authors: Schaefer
mesh_terms: D000367:Age Factors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D001208:Asia; D002648:Child; D015314:Dialysis Solutions / Q000009:adverse effects; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use; D005060:Europe; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D009656:North America; D009846:Oliguria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015314:Dialysis Solutions; D004232:Diuretics