title: Predictors of Residual Renal Function Decline in Peritoneal Dialysis Patients: ThebalANZ Trial.
abstract: ♦ OBJECTIVE: Preservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients. ♦ METHODS: The study included incident PD patients who werebalANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model. ♦ RESULTS: The study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m2at baseline to 3.3 ± 2.8 mL/min/1.73 m2at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation (p= 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation (p< 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV. ♦ CONCLUSIONS: Common modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.|Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Htay
authors.initials: H
authors.lastname: Htay
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Yeoungjee
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Darsy
authors.initials: D
authors.lastname: Darssan
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.|Translational Research Institute, Brisbane, Australia.
authors.forename: Carmel
authors.initials: C
authors.lastname: Hawley
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia david.johnson2@health.qld.gov.au.|Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.|Translational Research Institute, Brisbane, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D015314:Dialysis Solutions / Q000494:pharmacology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000379:methods*; D011379:Prognosis; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015314:Dialysis Solutions
keywords: Biocompatible materials; dialysis solutions; end-stage kidney disease; peritoneal dialysis; residual renal function; risk factors; urine volume