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Intra-abdominal pressure and residual renal function decline in peritoneal dialysis: a threshold-based investigation
Jingjing Zhang1,2, Lei Song2, Zhongwei Ma2
1Graduate School of Jinzhou Medical University, Jinzhou, PR China.
Insights
Elevated intra-abdominal pressure (IAP) significantly accelerates residual renal function (RRF) decline in peritoneal dialysis (PD) patients. Maintaining IAP below 15.65 cmH2O may help preserve RRF in early PD treatment.
Area of Science:
- Nephrology
- Renal Medicine
- Dialysis Technology
Background:
- Intra-abdominal pressure (IAP) impact on residual renal function (RRF) in peritoneal dialysis (PD) is not well-established.
- Understanding this relationship is crucial for optimizing PD patient management.
Purpose of the Study:
- To investigate the association between IAP and RRF decline rate in new PD patients.
- To determine an optimal IAP threshold for preserving RRF.
Main Methods:
- A cohort of 62 PD patients with 6- and 12-month follow-ups was analyzed.
- Logistic regression and ROC curves identified variables and thresholds for RRF decline.
- A retrospective analysis validated the findings.
Main Results:
- Each 1 cmH2O increase in IAP raised the risk of rapid RRF decline by 1.679.
- High IAP group showed significantly greater decreases in eGFR and urine volume.
- An IAP threshold of ≥15.65 cmH2O predicted RRF decline.
Conclusions:
- Higher IAP is linked to faster RRF loss in PD patients.
- An IAP of 15.65 cmH2O is a critical threshold for predicting RRF decline.
- Monitoring and managing IAP is important for RRF preservation in the first year of PD.
Background:
The potential impact of elevated intra-abdominal pressure (IAP) on residual renal function (RRF) has not been determined. The objective of this study was to investigate the relationship between IAP and the rate of RRF decline in newly initiated peritoneal dialysis (PD) patients, and to identify the optimal IAP threshold value for delaying the deterioration of RRF.
Methods:
A cohort of 62 newly initiated PD patients who completed both 6- and 12-month follow-up evaluations was obtained using the Durand method. A logistic regression model was used to identify variables associated with a rapid decline in RRF. Receiver operating characteristic (ROC) curves were generated to determine the optimal threshold value. Another retrospective cohort analysis was performed to validate the identified critical value.
Results:
For each 1 cmH2O increase in IAP, the risk of a rapid decline in the RRF increased by a factor of 1.679. Subsequent analysis revealed that patients in the high IAP group had more significant decreases in residual renal estimated glomerular filtration rate (eGFR) (Z = -3.694, p < 0.001) and urine volume (Z = -3.121, p < 0.001) than did those in the non-high IAP group. Furthermore, an IAP ≥15.65 cmH2O was a robust discriminator for the prediction of the rate of RRF decline.
Conclusion:
Patients in the high IAP group experienced a more rapid decline in RRF. Additionally, an optimal critical pressure of 15.65 cmH2O was identified for predicting the rate of RRF decline. IAP, as one of the factors contributing to the rapid decline in RRF in the first year of PD, should be given due attention.
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