TY - JOUR
T1 - Role of residual renal function in phosphate control and anemia management in chronic hemodialysis patients
AU - Penne, E. Lars
AU - Van Der Weerd, Neelke C.
AU - Grooteman, Muriel P.C.
AU - Mazairac, Albert H.A.
AU - Van Den Dorpel, Marinus A.
AU - Nube, Menso J.
AU - Bots, Michiel L.
AU - Lévesque, Renée
AU - Ter Wee, Piet M.
AU - Blankestijn, Peter J.
PY - 2011/2/1
Y1 - 2011/2/1
N2 - Background and objectives: There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients. Design, setting, participants, & measurements: Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output ≥100 ml/24 h (n = 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output <100 ml/24 h, n = 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models. Results: Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR > 4.13 ml/min per 1.73 m2), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 ± 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. Conclusions: This study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.
AB - Background and objectives: There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients. Design, setting, participants, & measurements: Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output ≥100 ml/24 h (n = 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output <100 ml/24 h, n = 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models. Results: Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR > 4.13 ml/min per 1.73 m2), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 ± 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. Conclusions: This study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.
UR - http://www.scopus.com/inward/record.url?scp=79951865856&partnerID=8YFLogxK
U2 - 10.2215/CJN.04480510
DO - 10.2215/CJN.04480510
M3 - Article
C2 - 21030579
AN - SCOPUS:79951865856
SN - 1555-9041
VL - 6
SP - 281
EP - 289
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -