Document Detail


Role of residual renal function in phosphate control and anemia management in chronic hemodialysis patients.
MedLine Citation:
PMID:  21030579     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output≥100 ml/24 h (n=295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output<100 ml/24 h, n=274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models.
RESULTS: Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR>4.13 ml/min per 1.73 m2), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9±1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients.
CONCLUSIONS: This study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.
Authors:
E Lars Penne; Neelke C van der Weerd; Muriel P C Grooteman; Albert H A Mazairac; Marinus A van den Dorpel; Menso J Nubé; Michiel L Bots; Renée Lévesque; Piet M ter Wee; Peter J Blankestijn;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2010-10-28
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  6     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-17     Completed Date:  2011-06-07     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  281-9     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Room F03.223, University Medical Center-Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00205556
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MeSH Terms
Descriptor/Qualifier:
Aged
Anemia / blood,  drug therapy*,  etiology,  physiopathology
Anuria / blood,  etiology,  physiopathology
Biological Markers / blood
Canada
Chi-Square Distribution
Chronic Disease
Cross-Sectional Studies
Female
Glomerular Filtration Rate*
Hematinics / therapeutic use*
Hematocrit
Hemoglobins / metabolism
Humans
Kidney / physiopathology*
Kidney Diseases / blood,  complications,  physiopathology,  therapy*
Linear Models
Logistic Models
Male
Middle Aged
Netherlands
Phosphates / blood*
Prospective Studies
Renal Dialysis*
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Hematinics; 0/Hemoglobins; 0/Phosphates
Investigator
Investigator/Affiliation:
P M ter Wee / ; P J Blankestijn / ; M L Bots / ; M A van den Dorpel / ; M P C Grooteman / ; M J Nubé / ; M Dorval / ; R Lévesque / ; M G Koopman / ; C J Konings / ; W P Haanstra / ; P Vos / ; T Noordzij / ; G W Feith / ; M van Buren / ; J J Offerman / ; E K Hoogeveen / ; F de Heer / ; P J van de Ven / ; T K Kremer Hovinga / ; W Bax / ; J O Groeneveld / ; A T Lavrijssen / ; A M Schrander-Van der Meer / ; L J Reichert / ; G J Bruinings / ; P L Rensma / ; Y Schrama / ; H W van Hamersvelt / ; W H Boer / ; W H van Kuijk / ; M G Vervloet / ; I M Wauters / ; I Sekse /
Comments/Corrections

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