RESIDUAL KIDNEY FUNCTION
Residual kidney function contributes significantly to small solute, middle molecule clearances and adequacy of dialysis.15 Preservation of residual kidney function is associated with better survival.4, 22 When the CANUSA data was reanalyzed, it became evident that it was kidney clearance and urinary volume that predicted survival in PD and not peritoneal clearance. Each 250-mL increase in daily urine volume was associated with a 36% lower relative risk (RR) of death, and every 0.5 mL/min/1.73m2 increment in residual GFR decreased the risk of mortality by 12%.16
Benefits of RKF include:
- Enhanced total solute clearance15
- Removal of sodium and water, facilitating easier volume management17
- Middle molecule clearance including beta-2-microglobulin15
- Improved phosphate control18
- Improved blood pressure control19
- Lower prevalence of left ventricular hypertrophy (LVH)20
- Better nutritional status21
- Unrecognized systemic metabolic effects15
Residual creatinine clearance overestimates the glomerular filtration rate (GFR) because of tubular secretion of creatinine. Conversely, urea clearance (Curea) underestimates GFR because of tubular urea reabsorption. Therefore, when calculating the weekly creatinine clearance (Ccr), it is recommended that the average of the two be used. When calculating the renal contribution to Kt/Vurea, the more conservative approach of using the actual urea clearance is recommended.11
Estimated GFR measurements by either the Modification of Diet in Renal Disease (MDRD) or the Cockroft-Gault formulas are useful adjuncts for assessing the contribution of RKF in patients on dialysis. However, both formulas lack accuracy in precise determination.24
