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Titolo Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis
Autore E. Lars Penne,*† Neelke C. van der Weerd,*† Muriel P.C. Grooteman,†± Albert H.A. Mazairac,* Marinus A. van den Dorpel,§ Menso J. Nube´,†± Michiel L. Bots, Rene´e Le´vesque,¶ Piet M. ter Wee,†± and Peter J. Blankestijn,* on behalf of the CONTRAST investigators
Referenza Clin J Am Soc Nephrol 2011; 6: 281-289
Contenuto 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.
Data 31.03.2011
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