title: Preservation of residual kidney function in hemodialysis patients: reviving an old concept.
abstract: Residual kidney function (RKF) may confer a variety of benefits to patients on maintenance dialysis. RKF provides continuous clearance of middle molecules and protein-bound solutes. Whereas the definition of RKF varies across studies, interdialytic urine volume may emerge as a pragmatic alternative to more cumbersome calculations. RKF preservation is associated with better patient outcomes including survival and quality of life and is a clinical parameter and research focus in peritoneal dialysis. We propose the following practical considerations to preserve RKF, especially in newly transitioned (incident) hemodialysis patients: (1) periodic monitoring of RKF in hemodialysis patients through urine volume and including residual urea clearance with dialysis adequacy and outcome markers such as anemia, fluid gains, minerals and electrolytes, nutritional, status and quality of life; (2) avoidance of nephrotoxic agents such as radiocontrast dye, nonsteroidal anti-inflammatory drugs, and aminoglycosides; (3) more rigorous hypertension control and minimizing intradialytic hypotensive episodes; (4) individualizing the initial dialysis prescription with consideration of an incremental/infrequent approach to hemodialysis initiation (e.g., twice weekly) or peritoneal dialysis; and (5) considering a lower protein diet, especially on nondialysis days. Because RKF appears to be associated with better patient outcomes, it requires more clinical and research focus in the care of hemodialysis and peritoneal dialysis patients.
authors.affiliation: Hofstra Northwell School of Medicine, Division of Kidney Diseases and Hypertension, Northwell Health, Great Neck, New York, USA.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Mathew
authors.affiliation: Hofstra Northwell School of Medicine, Division of Kidney Diseases and Hypertension, Northwell Health, Great Neck, New York, USA. Electronic address: sfishbane@nshs.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Fishbane
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA; Fielding School of Public Health at UCLA, Los Angeles, California, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000032:analysis; D018660:Blood Pressure Monitoring, Ambulatory; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D018753:Diet, Protein-Restricted; D004232:Diuretics / Q000627:therapeutic use; D004573:Electrolytes / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy; D007022:Hypotension / Q000175:diagnosis* / Q000517:prevention & control; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000628:therapy* / Q000652:urine; D008903:Minerals / Q000032:analysis; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D014508:Urea / Q000032:analysis*
chemical_list: D000617:Aminoglycosides; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D003287:Contrast Media; D004232:Diuretics; D004573:Electrolytes; D008903:Minerals; D014508:Urea
keywords: end-stage renal disease; incremental hemodialysis; residual kidney function