Prognosis of patients with acute renal failure requiring dialysis: Results of a multicenter study (original) (raw)
Dialyzer membrane permeability and survival in hemodialysis patients
American journal of …, 2005
the French Study Group for Nutrition in Dialysis • Background: We previously showed that nutritional protein concentrations were predictive of outcome, whereas variables reflecting body composition and dialysis dose were not, in a 30-month prospective follow-up of 1,610 hemodialysis patients. Information on dialysis membrane and erythropoietin use had to be evaluated in an additional follow-up. Methods: A subset of 650 patients from the initial cohort of 1,610 was analyzed for survival in a 2-year extension of follow-up. Detailed data were collected: demographics; cause of renal failure; time on dialysis therapy; type of membrane; erythropoietin treatment; body mass index (BMI); predialysis albumin, prealbumin, and bicarbonate levels; and outcome. Normalized protein catabolic rate (nPCR), dialysis adequacy, and lean body mass were computed from predialysis and postdialysis urea and creatinine values. Results: Patient characteristics were age of 61 ؎ 16 years, 58% men, BMI of 22.7 ؎ 4.4 kg/m 2 , time on dialysis therapy of 102 ؎ 73 months, and 8.8% had diabetes. Dialysis parameters were duration of 247 ؎ 31 minutes, Kt/V of 1.4 ؎ 0.3, and nPCR of 1.2 ؎ 0.3 g/kg/d. Albumin level was 3.73 ؎ 0.53 g/dL (37.3 ؎ 5.3 g/L), and prealbumin level was 31 ؎ 8 mg/dL. The survival rate was 78.7% after 2 years. Survival was influenced by age, presence of diabetes, use of high-flux membrane, and serum albumin level, but not other variables, including Kt/V and prealbumin level. Two-year variations in values for urea, creatinine, and weight were predictive of survival in univariate, but not multivariate, analyses. Conclusion: In patients on dialysis therapy for a long period, better survival was observed when high-flux dialysis membranes were used. Am J Kidney Dis 45:565-571.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2016
♦ Background and objective: Residual renal function (RRF) correlates with mortality and morbidity rates in patients receiving peritoneal dialysis (PD). We examined the effect of a biocompatible PD solution (Gambrosol Trio; Gambro Lundia AB, Lund, Sweden) with lower concentrations of glucose degradation products on rates of decline in RRF. ♦ Design, setting, participants, and measurements: Incident patients at 2 centers in Canada and 1 in Hong Kong were randomized (by minimization) in an open-label parallel group trial to receive Gambrosol Trio or standard PD solution (Dianeal; Baxter Healthcare, Mississauga, Canada) for 2 years. Primary outcome was slope of RRF. Secondary outcomes were urine volumes, fluid and nutrition indices, PD and membrane characteristics, peritonitis rates, adverse events, and PD technique survival. ♦ Results: Residual renal function declined by 0.132 mL/minute/1.73 m(2)/month in 51 patients allocated to biocompatible, and 0.174 mL/minute/1.73 m(2)/month in 50...
Renal Failure, 2001
Despite the widespread availability of dialytic and intensive care unit technology, the probability of early mortality in critically ill patients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is a reliable indicator of severity of illness and likelihood of survival in critically ill patients with ARF. We have attempted to determine whether the APACHE II scoring system can be used to predict prognosis. Methods: A retrospective cohort study evaluated the medical records of 100 consecutive patients in intensive care units with acute renal failure who required dialysis from January 1997 through December 1998. Results: Of the 100 patients studied, 65 were men and 35 were women. The mean age of survivors and nonsurvivors was 59.4 ± 20.3 years and 58.3 ± 20.0 years. The overall mortality rate was 71%. There were no significant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. The cause of death in the majority of patients was related to higher APACHE II score during the 24 hours immediately preceding the initiation of acute hemodialysis, and carry mortality rates exceeding 85% with an APACHE II score of 24 or higher.
Artificial Organs, 2007
Dialysis adequacy indices that are applied for the evaluation of the efficiency of urea removal include fractional water volume cleared from urea during dialysis (KT T/V), fractional solute removal (FSR), and equivalent urea clearance (EKR). Using a constant-volume, onecompartment urea kinetic model for an anuric patient, the FSR and EKR are shown to depend on only three nondimensional parameters: (i) KT/V, where K is the dialyzer clearance for hemodialysis (HD) or peritoneal mass transport coefficient for peritoneal dialysis (PD), T is the time period of dialysis, and V is urea distribution volume; (ii) T/Tc, where Tc is the length of treatment cycle; and (iii) VD/V, where VD is the volume of dialysis fluid applied. In particular, analytical formulas for FSR and EKR, valid for HD as well as for PD, were derived as functions of these three parameters. Numerical simulations, performed using a two-compartment urea kinetic model, showed that the analytical formulas are valid also for the two-compartment model, except for short, highly effective HD, where the overestimation of FSR and EKR using the analytical formulas is however, not higher than 20 and 16%, respectively. KT T/V is equal to KT/V for HD and FSR for PD. Thus, our formulas provide an integrative description of the relationships between dialysis efficiency indices and operational dialysis parameters that is valid for all modalities and schedules of dialysis. They may be applied not only for standard HD and continuous ambulatory PD, but also for HD with circulating dialysis fluid or intermittent forms of PD.
Nephrology Dialysis Transplantation, 2005
Background. Residual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Whether results from survival studies in dialysis patients with RRF can also be extrapolated to anuric patients remains uncertain. In this observational study, we examined the characteristics of PD patients with a residual glomerular filtration rate (GFR) !1 ml/min per 1.73 m 2 vs those with complete anuria and differentiated factors that predict outcome in the two groups of patients. Methods. Two hundred and forty-six continuous ambulatory peritoneal dialysis (CAPD) patients (39% being completely anuric) were recruited from a single regional dialysis centre. Assessments of haemodynamic, echocardiographic, nutritional and biochemical parameters and indices of dialysis adequacy were done at study baseline and were related to outcomes. Results. During the prospective follow-up of 30.8±13.8 (mean±SD) months, 28.0% of patients with residual GFR !1 ml/min per 1.73 m 2 vs 50.5% of anuric patients had died (P ¼ 0.005). The overall 2 year patient survival was 89.7 and 65.0% for patients with GFR !1 ml/min per 1.73 m 2 and anuric patients, respectively (P ¼ 0.0012). Compared with patients with GFR !1 ml/min per 1.73 m 2 , anuric patients were dialysed for longer (P<0.001), were more anaemic (P<0.005), and had higher calcium-phosphorus product (P<0.01), higher C-reactive protein (P<0.001), lower serum albumin (P<0.05), greater prevalence of malnutrition according to subjective global assessment (P<0.05) and more severe cardiac hypertrophy (P<0.001) at baseline. Using multivariable Cox regression analysis, serum albumin, left ventricular mass index and residual GFR were significant factors associated with mortality in patients with GFR !1 ml/ min per 1.73 m 2 , while increasing age, atherosclerotic vascular disease and higher C-reactive protein were associated with greater mortality in anuric PD patients. Conclusions. Our study demonstrates more adverse cardiovascular, inflammatory, nutritional and metabolic profiles as well as higher mortality in anuric PD patients. Furthermore, factors associated with mortality are also not equivalent for PD patients with and without RRF, suggesting that patients with and without RRF are qualitatively different. all rights reserved by guest on December 3, 2015 http://ndt.oxfordjournals.org/ Downloaded from Peritoneal dialysis in anuric ESRD patients 397 by guest on December 3, 2015 http://ndt.oxfordjournals.org/ Downloaded from PVD ¼ peripheral vascular disease; HD ¼ haemodialysis; CAPD ¼ continuous ambulatory peritoneal dialysis. a P<0.05, patients with GFR !1 ml/min per 1.73 m 2 vs anuric patients. 400 A.Y.-M. Wang et al. by guest on December 3, 2015
Identical decline of residual renal function in high-flux biocompatible hemodialysis and CAPD
Kidney International, 2002
Identical decline of residual renal function in high-flux biocomrenal function has been lost [1]. The capacity to increase patible hemodialysis and CAPD. small solute clearance using larger dialyzers, increased Background. Patients on conventional hemodialysis lose reblood and dialysis fluid flow rates, and increased treatsidual renal function more rapidly than patients on continuous ment times has meant that the maintenance of adequate ambulatory peritoneal dialysis (CAPD). The effect of dialysis hemodialysis (HD) is much less dependent on residual using synthetic membranes and ultrapure water is less clear. Methods. The decline of urea clearance was compared in a renal function. Because of this, and the notion that residcohort of 475 incident end-stage renal failure patients who ual renal function is lost more rapidly in HD than in received treatment with CAPD (N ϭ 175) or hemodialysis CAPD [2-5], the practice has evolved in many units to (HD) utilizing high-flux polysulphone membranes, ultrapure prescribe HD without reference to residual renal funcwater, and bicarbonate as the buffer (N ϭ 300). tion. Current interest in the concept of incremental dial-Results. CAPD patients were significantly younger, fitter (lower comorbidity severity score), less dependent (higher Karysis [6] challenges this practice and highlights the impornofsky performance score) and less likely to have presented tance of residual renal function in HD as well as CAPD. late than HD patients. There was no difference in the mean Preservation of residual renal function is emerging as an urea clearance in each group at dialysis initiation, or at any important therapeutic goal [7]. There have been sugges-6-month time point during the ensuing 48 months. This was tions that use of modern synthetic membranes may retrue even after exclusion of patients who had died in the first year after initiation, those transferred to another dialysis modduce the rate of loss of residual renal function in HD, ality, or those who had been transplanted. Only age and chronic though this is still controversial [8-11]. If this were true interstitial disease predicted retention of urea clearance at one then preservation of residual renal function may be a year. The rate of decline of urea clearance was similar in prefurther indication for use of such membranes. To investiand post-dialysis initiation phases, though there may have been a step-decline of about 2 mL/min at initiation, which requires gate this hypothesis, we studied the rate of decline of further investigation. residual renal function before and after dialysis initiation Conclusions. In hemodialysis using high-flux biocompatible in a large group of incident end-stage renal failure (ESRF) membranes and ultrapure water, residual renal function declines patients treated in a single center. Our aim was to analyze at a rate indistinguishable from that in CAPD. This may have the impact of dialysis initiation and dialysis modality on important implications, since preservation of residual renal function has major benefits and is a valid therapeutic goal. the rate of decline of residual renal function. METHODS During the past decade it has been recognized that Patients residual renal function makes a crucial contribution to the adequacy of continuous ambulatory peritoneal dial-We studied all patients beginning dialysis in the Lister ysis (CAPD), such that the technique is often not viable Renal unit between January 1, 1990 and June 30, 1997. in patients of above average body size, once residual Patients transferred from other units who were already on dialysis were excluded. Patients who started dialysis in our unit but were subsequently transferred out also
American Journal of Kidney Diseases, 1996
0 The aim of this study was to describe a relationship between intensive care unit (CU) patient acuity, delivered diatysis dosing, and patient mortality from newly acquired acute renal failure (ARF) requiring dialytic support. A prospectively collected ICU ARF registry formed the basis for data comparison. Ail data was verified. Eight hundred forty-four ICU patients were identified who met biochemical or clinical criteria of ARF and required first-time dialytic support. An acute dialysis scoring system was established using 23 independent variables identified with univariant analysis, and reduced to eight variables with multiple regression analysis in 512 patients. These eight variables were assigned a weighted score derived from their odds ratio, and the scoring system was than validated prospectively to either registry data not involved in the generation of the system (n = 148), or double-blinded score assignment at time of first dialysis (n = 188). Several established scoring systems were also applied to the database for external comparison.