Determining factors of diuresis in chronic kidney disease patients initiating hemodialysis.
BACKGROUND
Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved.


OBJECTIVE
The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis.


METHODS
216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day).


RESULTS
Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis.


CONCLUSIONS
In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.
Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania.
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Nechita
Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania ; Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
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D
Rădulescu
Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania ; Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
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I
Peride
Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania.
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A
Niculae
Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania ; Department of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania.
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O
Bratu
Department of Physiology I, Clinical Department No. 2, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
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Ferechide
Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania ; Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
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Ciocâlteu
Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania ; Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
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IA
Checheriță
Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania ; Department of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania.
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D
Mischianu
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000418:Albumins / Q000378:metabolism; D004231:Diuresis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000503:physiopathology; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D013599:Systole; D055815:Young Adult
D000418:Albumins
hemodialysis; residual diuresis; stage 5 chronic kidney disease