Contribution of 'clinically negligible' residual kidney function to clearance of uremic solutes
| Autor: | Stephanie M. Toth-Manikowski, Thomas H. Hostetter, Tariq Shafi, Xin Hai, Natalie S. Plummer, Josef Coresh, Seungyoung Hwang, Neil R. Powe, Timothy W. Meyer, Tammy L. Sirich |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Kidney Disease medicine.medical_treatment Urinary system uremic toxins Clinical Sciences 030232 urology & nephrology Urology Renal and urogenital Renal function Bioengineering clearance 030204 cardiovascular system & hematology Lower risk Kidney Kidney Function Tests Cardiovascular Kidney Failure 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Renal Dialysis Clinical Research Medicine Humans Urea Chronic ESRD Dialysis Transplantation hemodialysis business.industry dialysis dose Middle Aged Urology & Nephrology Confidence interval chemistry Nephrology Uremic toxins Kidney Failure Chronic Female Hemodialysis business Asymmetric dimethylarginine |
| Zdroj: | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association-European Renal Association, vol 35, iss 5 |
| Popis: | BackgroundResidual kidney function (RKF) is thought to exert beneficial effects through clearance of uremic toxins. However, the level of native kidney function where clearance becomes negligible is not known.MethodsWe aimed to assess whether levels of nonurea solutes differed among patients with ‘clinically negligible’ RKF compared with those with no RKF. The hemodialysis study excluded patients with urinary urea clearance >1.5 mL/min, below which RKF was considered to be ‘clinically negligible’. We measured eight nonurea solutes from 1280 patients participating in this study and calculated the relative difference in solute levels among patients with and without RKF based on measured urinary urea clearance.ResultsThe mean age of the participants was 57 years and 57% were female. At baseline, 34% of the included participants had clinically negligible RKF (mean 0.7 ± 0.4 mL/min) and 66% had no RKF. Seven of the eight nonurea solute levels measured were significantly lower in patients with RKF than in those without RKF, ranging from −24% [95% confidence interval (CI) −31 to −16] for hippurate, −7% (−14 to −1) for trimethylamine-N-oxide and −4% (−6 to −1) for asymmetric dimethylarginine. The effect of RKF on plasma levels was comparable or more pronounced than that achieved with a 31% higher dialysis dose (spKt/Vurea 1.7 versus 1.3). Preserved RKF at 1-year follow-up was associated with a lower risk of cardiac death and first cardiovascular event.ConclusionsEven at very low levels, RKF is not ‘negligible’, as it continues to provide nonurea solute clearance. Management of patients with RKF should consider these differences. |
| Databáze: | OpenAIRE |
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