Related Experiment Video
Updated: Jun 23, 2025
5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
Longitudinal Changes in Kidney Solute Clearance in a Prospective Cohort of Patients Initiating Chronic Hemodialysis
Tammy L Sirich1,2, Zijian Tan3, Benjamin R Highland3
1Department of Medicine, Stanford University, Palo Alto, California, USA.
Insights
Residual kidney function declines over one year of chronic hemodialysis (HD), with urine volume and solute clearances decreasing at different rates. Conventional HD showed faster declines than incremental HD initially.
Area of Science:
- Nephrology
- Renal Medicine
- Dialysis Research
Background:
- Longitudinal changes in residual kidney function (RKF) in patients initiating chronic hemodialysis (HD) are not well-documented.
- RKF plays a crucial role in patient outcomes and quality of life during dialysis therapy.
Purpose of the Study:
- To investigate the temporal trends of residual kidney function in patients starting chronic hemodialysis.
- To compare the decline in RKF between incremental HD and conventional HD treatment strategies.
Main Methods:
- Analysis of urine volume and kidney solute (urea and creatinine) clearances from 42 patients in the TwoPlus pilot study.
- Data collection at baseline and at 6, 12, 24, and 48 weeks post-HD initiation.
- Comparison of RKF parameters between incremental HD (n=21) and conventional HD (n=21) groups.
Main Results:
- All patients experienced a decline in RKF parameters over 48 weeks.
- Urine volume declined steadily, while kidney solute clearances showed a faster initial decline that slowed over time.
- Conventional HD was associated with greater initial declines in urine volume and urea clearance compared to incremental HD.
Conclusions:
- Residual kidney function persists for nearly a year after initiating hemodialysis, despite gradual decline.
- Individualizing hemodialysis prescriptions by considering residual kidney function is recommended.
Introduction:
Longitudinal changes in residual kidney function have not been well-examined in patients starting chronic hemodialysis (HD).
Methods:
We analyzed urine volume and kidney solute clearances from timed urine collections and corresponding plasma samples from 42 patients randomized to incremental HD (n = 21) and conventional HD (n = 21) in the TwoPlus pilot study. Samples were collected before HD initiation (baseline); and at 6, 12, 24, and 48 weeks. We assessed temporal trends in urine volume, kidney urea and creatinine clearance, and correlations between urine volume and kidney solute clearance.
Results:
Residual kidney function parameters in all patients declined over time; the pattern of decline differed between urine volume and kidney solute clearances. Urine volume declined at a steady rate with median (quartile 1, quartile 3) percentage change relative to baseline of -10% (-36 to 29) at week 6 and -47% (-76 to 5) by week 48. Kidney urea and creatinine clearances exhibited a larger decline than urine volume at week 6, -32% (-61 to 8) and -47% (-57 to -20), respectively. The rate of decline subsequently slowed, reaching about 61% decline for both solutes by week 48. Conventional HD demonstrated larger declines in urine volume and kidney urea clearance than incremental HD at week 6. Urine volume showed moderate correlation with urea (R = 0.47) and weaker correlation with creatinine (R = 0.34).
Conclusion:
Despite gradual decrement in urine volume and kidney solute clearances, residual kidney function persists nearly 1 year after HD initiation. This knowledge could motivate increased practice of individualizing HD prescriptions by incorporating residual kidney function.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:31Factors Affecting Renal Clearance: Drug's Physicochemical Properties and Plasma Levels
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
01:06Renal Drug Clearance: Overview
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
Renal clearance is often associated with the renal glomerular filtration rate (GFR), which represents the rate at which plasma is filtered through the glomeruli in the kidney. When drug reabsorption is minimal and there is no active secretion, renal clearance is closely related to the...