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Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic
Qian Shen1, XiaoYan Fang1, YiHui Zhai1
1Department of Nephrology, Children's Hospital of Fudan University, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China.
Insights
Automated peritoneal dialysis (APD) in children with end-stage renal disease risks residual renal function (RRF) loss due to low initial urine volume, high glucose exposure, and high ultrafiltration. Diuretic use may preserve RRF.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis
Background:
- End-stage renal disease (ESRD) in children necessitates renal replacement therapy.
- Automated peritoneal dialysis (APD) is a common treatment modality for pediatric ESRD.
- Understanding factors affecting residual renal function (RRF) is crucial for long-term management.
Purpose of the Study:
- To identify risk factors associated with the loss of residual renal function (RRF) in children undergoing APD.
- To explore protective factors for maintaining RRF during APD treatment.
Main Methods:
- Retrospective analysis of pediatric patients with ESRD treated with APD from 2008-2016.
- Inclusion criteria: initial daily urine volume ≥100 ml/m², dialysis follow-up ≥12 months.
- RRF loss defined as daily urine volume <100 ml/m² after 12 months of APD.
Main Results:
- 43.9% of 66 children experienced RRF loss after 12 months of APD.
- Risk factors for RRF loss included low baseline urine volume (≤400 ml/m²), high glucose exposure, and high ultrafiltration volume.
- Diuretic use was associated with a lower risk of RRF loss.
Conclusions:
- Low initial urine volume, high glucose exposure, and high ultrafiltration volume are significant risk factors for RRF loss in pediatric APD patients.
- Diuretics may play a role in preserving residual renal function during APD.
- Further research is warranted to optimize APD protocols for RRF preservation.
Background:
This study analysed children with end-stage renal disease treated with automated peritoneal dialysis (APD) in our centre to explore the risk factors associated with residual renal function (RRF) loss.
Methods:
Children treated with APD as the initial renal replacement therapy regimen from January 2008 to December 2016 were included. All the children had a daily urine volume of ≥100 ml/m2 when APD was initiated and a dialysis follow-up time of ≥12 months. A daily urine volume of <100 ml/m2 after 12 months of APD treatment was defined as loss of RRF. Possible risk factors that may be associated with RRF loss were analysed.
Results:
A total of 66 children were included in the study. After 12 months of APD treatment, the daily urine volume decreased by 377.45 ± 348.80 ml/m2, the residual glomerular filtration rate decreased by 6.39 ± 3.69 ml/min/1.73 m2 and 29 of the patients (43.9%) developed RRF loss. The higher risk of RRF loss after 1 year of APD treatment was most pronounced in patients with daily urine volume of ≤400 ml/m2 before treatment, higher glucose exposure and higher ultrafiltration volume, while the lower risk of RRF loss was in patients with administration of diuretics. Each increase of 1 g/m2/day glucose exposure was associated with a 5% increase in RRF loss (odds ratio (OR) 1.05, p = 0.023) and each increase of 1 ml/m2/day ultrafiltration volume was associated with a 1% increase in RRF loss (OR 1.01, p = 0.013).
Conclusion:
In children undergoing APD, the risk for loss of RRF is associated with low urine volume at the start of APD, high glucose loading and high peritoneal ultrafiltration volume, while preservation of RRF is associated with the usage of diuretics.
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