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Residual renal function in children on haemodialysis and peritoneal dialysis therapy
J Feber1, K Schärer, F Schaefer
1Division of Paediatric Nephrology, University Children's Hospital Heidelberg, Germany.
Insights
Peritoneal dialysis (PD) better preserves residual renal function, specifically urine output, in pediatric patients compared to hemodialysis (HD). This finding highlights PD as a potentially superior treatment for maintaining kidney function in children undergoing dialysis.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Residual renal function is crucial for managing pediatric patients on dialysis.
- Understanding the impact of dialysis modality on residual renal function is essential for long-term patient outcomes.
Purpose of the Study:
- To compare the preservation of residual renal function, specifically urine volume, between pediatric patients treated with hemodialysis (HD) and peritoneal dialysis (PD).
Main Methods:
- Prospective study of 28 pediatric hemodialysis patients and 31 pediatric peritoneal dialysis patients over 6-43 months.
- Analysis of urine volume (UV) changes over time and comparison between HD and PD groups.
- Cox proportional hazard analysis to identify risk factors for UV survival.
Main Results:
- Urine volume significantly decreased over time in both HD and PD patients, but at different rates.
- PD patients maintained significantly higher mean urine volume (954 ml/m2/24h) compared to HD patients (537 ml/m2/24h).
- PD demonstrated a longer persistence of urine output greater than 500 ml/m2/24h.
- Dialysis modality and pre-dialysis urine volume (<1000 ml/m2/24h) were significant risk factors for urine volume survival.
Conclusions:
- Peritoneal dialysis is associated with better preservation of residual renal function, particularly urine output, in pediatric patients compared to hemodialysis.
- While urine volume declines in both modalities, PD offers a survival advantage for diuresis.
- Glomerular filtration rate remained stable in both treatment groups throughout the study period.
Abstract:
Residual renal function was studied in 28 haemodialysis (HD) and 31 peritoneal dialysis (PD) patients aged 1-20 years observed over 6-43 (median 19) months. After the start of dialysis urine volume (UV) decreased to 57%, 46% and 26% of initial mean values in HD patients after 6, 12 and 24 months, respectively. In PD patients the corresponding figures were 57%, 69% and 62%. Mean UV calculated from all individual mean UV measurements observed was higher in PD than HD patients (954 vs. 537 ml/m2 per 24 h, P < 0.01). A better conservation of diuresis in PD patients was also suggested by a significantly longer persistence of a UV greater than 500 ml/m2 per 24 h compared with HD patients. Cox proportional hazard analysis identified dialysis modality and pre-dialysis UV of less than 1,000 ml/m2 per 24 h as the only significant risk factors for UV survival. However, the decline of UV per time was similar in both modes of treatment. No significant changes of glomerular filtration rate were observed during both HD and PD treatment.