Journal Club: Residual renal function


Published on

Here is a nice presentation by Dr.Peter Schrier on Residual renal function in hemodialysis patients

Published in: Education
1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • More questions than answers- which function of the kidney is most important?
  • 11% decreased mortality with ~ 1cc/min/1.73m2. 10L/wk=1cc/min/1.73m2
  • For each 1m./min/1.73m2 increase in eGFR was associated with a 12% lower mortality (RR 0.88) compared with zero rGFR
  • rGFR is calculated as average of Renal creatinine clearance and renal nitrogen clearance (BUN)
  • 5L/wk/1.73m2 = .49 cc/min/1.73m2, again 12% reduced mortality for every .5 cc/min/1.73m2 residual renal function [here GFR= native kidney]
  • Entirely disappears when you factor in urine volume produced. Urine volume produced is the best prognosticator of mortality in PD patients. So maybe volume control and fluid shifting is more important than clearance
  • European descent, relatively healthy, older (mean age 66), LAST POINT= Prevalence, not incidence
  • 65% lower mortality within two years if patient produces > 100cc/day urine
  • Delivered Kt/V split into quintiles in aneuric patients and in patients with RRF intact (urine>100cc/24h)
  • RR 0.44 (56% decreased mortality) per 1 unit increase in the 1-week rKt/V during follow-up of 1.7 yrs. Data collected at month#3 and every 6 months thereafter. RR calculated on having renal function at given time t/ time of death? Which rKt/V was used for each patient?
  • A positive Beta estimate indicates a beneficial effect; a negative Beta estimate indicates an unfavorable effect on a QoL dimension. For all dimensions shown, a higher rGFR was associated with a better QoL. For example, an increase in the rGFR with 10 mL/min/1.73 m 2was associated with an increase in the score for “Physical functioning” by 7.28. This difference on a scale ranging from 0 to 100 (Table 2) may be regarded as small but was highly significant (P = 0.0001). For the majority of the other dimensions the association with the rGFR was significant as well. The associations between pCrCl and QoL dimensions were either in a positive or negative direction, and no association was statistically significant at the 5% level.
  • Preserved urine output more likely to be white, have higher systolic BP, higher pulse pressure at baseline, but only more likely to be white by year one.
  • Late referral= < 4 mo between first nephrology evaluation and starting dialysis
  • D Demographic characteristics: age, race (white or other), sex, educational status (completed high school or not), marital status (married or not), and employment status (employed or not employed).
  • Highlight the statistically significant ones- most are not!
  • The Endocrine Kidney
  • ×