Does Residual Renal Function Have a Beneficial Effect on Patient and Technique Survival in Peritoneal Dialysis Patients?

Objectives: Residual renal function (RRF) at the initiation of peritoneal dialysis (PD) therapy can be a predictor of survival in stable PD patients. The aim of the present study was to investigate PD patients regarding the effect of baseline RRF on patient and technique survival.
Methods: Urine output at the beginning of PD therapy was evaluated retrospectively in 202 PD patients. Patients were divided into two groups: patients with anuria (urine output ≤100 ml/day) and patients without anuria (urine output >100 ml/day).
Results: The number of patients with anuria was 58 in which 38 patients were females. The mean age of the patients was 42.8±14.9 years. The mean follow-up period was 44.2±35 months. Twelve percent of patients with anuria had history of hemodialysis (HD).
One hundred forty-four had no anuria (68 females, mean age 43.7±14.5 years, mean follow-up period 39.6 ± 26.1 months, mean urine volume 592±442 ml). Twenty-three patients had received HD therapy before. Sixty-five had anuria in the following 22.5±19.6 months.
At the beginning of therapy, systolic and diastolic blood pressures were lower in patients with oliguria than in patients without oliguria (p<0.001), but C-reactive protein (p=0.004) and ferritin (p<0.001) levels were higher. There was no difference between two groups regarding the other parameters (age, follow-up periods, presence of diabetes, ultrafiltration volumes, albumin, hemoglobin, calcium phosphorus product, parathormone, and Kt/V levels) (p>0.05).
The peritonitis rate was one episode per 28.2 versus 30 patient-months for the anuric and non-anuric groups, respectively (p>0.05).
For Kaplan–Meier survival analysis, the mean technique survival rates at 1 and 3 years were 97% and 86.6% in patients without anuria and 94% and 85.3% in patients with anuria, respectively. The 5-year technique survival rates according to residual volume states were not statistically significant with log-rank test (p>0.05).
The 1-, 3-, and 5-year survival rates were 96.9%, 89.6%, and 86.5% in patients without anuria, respectively, whereas they were 87.3%, 77.3%, and 53.7% in patients with anuria, respectively. The 5-year survival rates according to residual volume states were statistically significant (p<0.05).
Conclusion: RRF at the beginning of PD has an important and positive impact on patient survival in PD patients. Peritonitis rates and technique survival were not different for patients with anuria and without anuria.

Periton diyaliz hastalarýnda rezidüel renal fonksiyonun hasta ve teknik saðkalýmýna yararlý etkisi var mýdýr?

Amaç: Periton diyalizi (PD) baþlangýcýndaki rezidüel renal fonksiyon (RRF) hastalarýn saðkalýmýnýn öngörülmesini saðlayabilir. Çalýþmanýn amacý baþlangýçtaki RRF’nin PD hasta ve teknik saðkalýmýna olan etkisinin incelenmesidir.
Metot: Toplam 202 PD hastasýnýn verileri geriye dönük olarak baþlangýçtaki idrar miktarlarýna göre incelendi. Hastalar anürik (idrar miktarý <100ml/gün) ve anürik olmayan (idrar miktarý >100ml/gün) olmak üzere iki gruba ayrýldý.
Bulgular: PD baþlangýcýnda 58 hasta (38 kadýn, ort. yaþ 42.8±14.9 yýl, ort. takip süresi 44.2±35 ay) anürik idi. Bunlarýn 28’i daha önce hemodiyaliz tedavisi görmüþtü.
Anürik olmayan hasta sayýsý 144 (68 kadýn, ort. yaþ 43.7±14.5 yýl, ort. takip süresi 39.6±26.1 ay, ort. idrar miktarý 592±442 ml/gün) idi. Daha önce 23 hasta hemodiyaliz tedavisi almýþtý. Ortalama 22.5±19.6 ay sonra 65 hasta anürik hale geldi.
Tedavinin baþlangýcýnda, anürik hastalarda, anürik olmayanlara göre, sistolik ve diastolik kan basýncý daha düþük (p<0.001), CRP (p=0.004) ve ferritin (p<0.001) düzeyi daha yüksek idi. Ýki grup arasýnda yaþ, takip süresi, diyabet varlýðý, ultrafiltrasyon volümleri, albümin, hemoglobin, parathormon düzeyleri, kalsiyum fosfor çarpýmý, Kt/V deðerleri benzer idi(p>0.05).
Kaplan-Meier saðkalým eðrisine gore, anürik olmayan hastalarda 1 ve 3. yýllardaki saðkalým sýrasý ile %97 ve %86.6; anürik hastalarda ise sýrasý ile %94 ve %85.3 idi. Beþ yýlýlk teknik saðkalým iki grup arasýnda benzer saptandý (p>0.05).
Hasta saðkalýmý anürik olmayan hastalarda 1, 3, 5. yýllarda sýrasý ile %96.9, %89.6 ve %86.5 iken anürik hastalarda sýrasý ile 87.3%, 77.3% and 53.7% saptandý. Beþ yýllýk hasta saðkalýmý iki grup arasýnda anlamlý olarak farklý bulundu (p<0.05).
Sonuç: Periton diyaliz baþlangýcýnda rezidüel renal fonksiyonun varlýðý hasta saðkalýmýna pozitif etkide bulunmaktadýr. Teknik saðkalým ve peritonit oranlarý anürik ve anürik olmayan hastalar arazýnda benzerlik göstermektedir.