Clinical benefit of preserving residual renal function in patients after initiation of dialysis

Preserving residual renal function (RRF) after initiation of dialysis therapy is desirable for improving quality of life in ESRD patients. It has been believed that RRF declines more slowly in patients receiving continuous ambulatory peritoneal dialysis (CAPD) than in patients treated with other forms of maintenance dialysis. Episodes of intravascular volume depletion might be expected to cause more rapid loss of RRF, and are more frequent in patients on hemodialysis, which is intermittent therapy. However, recently it was demonstrated that in hemodialysis using high-flux biocompatible membrane and ultrapure water, RRF declines at a rate indistinguishable from that in CAPD. The HDF using ultrapure dialysate and the substitution fluid may show to preserve RRF as well as CAPD patients. In future, it might be a major concern for the assessment of the HDF by a multicenter clinical study for preserving RRF.