Background/Aims: Few data are available on the impact of residual renal function (RRF) on mortality and hospitalization in hemodialysis (HD) patients. The objective of our study was to compare clinical outcomes for HD patients with and without RRF. Methods: In a cohort of 118 incident HD patients with RRF (n = 51) and without RRF (n = 67) who started dialysis in a single center, we recorded demographics, laboratory data, medication, hospitalizations and mortality. Results: Patients without RRF were older (p = 0.007), had lower baseline serum albumin levels (p = 0.002) and spent 18.6 more days in hospital per year than those with RRF (p = 0.055). Mean survival time was significantly lower in patients without RRF (p = 0.027). In a Cox proportional hazards model, only RRF remained as a significant independent predictor. Conclusions: RRF is associated with significantly reduced mortality and hospital days, but does not decrease the hospitalization rate and time to first hospitalization.

Termorshuizen F, Korevaar JC, Dekker FW, et al; NECOSAD Study Group: The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. Am J Kidney Dis 2003;41:1293–1302.
Morduchowicz G, Winkler J, Zabludowski JR, et al: Effects of residual renal function in hemodialysis patients. Int Urol Nephrol 1994;26:125–131.
Wang AY, Woo J, Wang M, et al: Important differentiation of factors that predict outcome in peritoneal dialysis patients with different degrees of residual renal function. Nephrol Dial Transplant 2005;20:396–403.
Wang AY, Sea MM, Ip R, et al: Independent effects of residual renal function and dialysis adequacy on actual dietary protein, calorie, and other nutrient intake in patients on continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 2001;12:2450–2457.
Pecoits-Filho R, Heimburger O, Barany P, et al: Associations between circulating inflammatory markers and residual renal function in CRF patients. Am J Kidney Dis 2003;41:1212–1218.
Wang AY, Wang M, Woo J, et al: A novel association between residual renal function and left ventricular hypertrophy in peritoneal dialysis patients. Kidney Int 2002;62:639–647.
Wang AY, Wang M, Woo J, et al: Inflammation, residual renal function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. J Am Soc Nephrol 2004;15:2186–2194.
Bargman JM, Thorpe KE, Churchill DN: Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001;12:2158–2162.
Shemin D, Bostom AG, Lambert C, et al: Residual renal function in a large cohort of peritoneal dialysis patients: change over time, impact on mortality and nutrition. Perit Dial Int 2000;20:439–444.
Shemin D, Bostom AG, Laliberty P, Dworkin LD: Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis 2001;38:85–90.
US Renal Data System: USRDS 2009 Annual Data Report. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2009.
Chertow GM, Goldstein-Fuchs DJ, Lazarus JM, et al: Prealbumin, mortality, and cause-specific hospitalization in hemodialysis patients. Kidney Int 2005;68:2794–2800.
Li S, Foley RN, Collins AJ: Anemia, hospitalization, and mortality in patients receiving peritoneal dialysis in the United States. Kidney Int 2004;65:1864–1869.
Locatelli F, Pisoni RL, Combe C, et al: Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004;19:121–132.
Ma JZ, Ebben J, Xia H, Collins AJ: Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol 1999;10:610–619.
Rocco MV, Soucie MJ, Reboussin DM, McClellan WM: Risk factors for hospital utilization in chronic dialysis patients. J Am Soc Nephrol 1996;7:889–896.
Arora P, Kausz A, Obrador G, et al: Hospital utilization among chronic dialysis patients. J Am Soc Nephrol 2000;11:740–746.
Owen WF, Lew NL, Liu Y, Lowrie EG, Lazarus JM: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993;329:1001–1006.
Termorshuizen F, Dekker FW, van Manen JG, Korevaar JC, Boeschoten EW, Krediet RT, NECOSAD Study Group: Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. J Am Soc Nephrol 2004;15:1061–1070.
Tattersall J, Greenwood R, Farrington K: Urea kinetics and when to commence dialysis. Am J Nephrol 1995;15:283–289.
Mix TC, St peter WL, Ebben J, et al: Hospitalization during advancing chronic kidney disease. Am J Kidney Dis 2003;42:972–981.
Obrador GT, Arora P, Kausz AT, Ruthazer R, Pereira BJ, Levey AS: Level of renal function at the initiation of dialysis in the US end-stage renal disease population. Kidney Int 1999;56:2227–2235.
Kausz AT, Obrador GT, Arora P, Ruthazer R, Levey AS, Pereira BJ: Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol 2000;11:2351–2357.
Combes A, Luvt CE, Fagon JY, Wolff M, Trouillet JL, Chastre J: Early predictors for infection recurrence and death in patients with ventilator-associated pneumonia. Crit Care Med 2007;35:146–154.
Allon M, Radeva M, Bailey J, et al; HEMO Study Group: The spectrum of infection-related morbidity in hospitalized haemodialysis patients. Nephrol Dial Transplant 2005;20:1180–1186.
Kaysen GA, Dubin JA, Muller HG, Rosales LM, Levin NW: The acute-phase response varies with time and predicts serum albumin levels in hemodialysis patients. The HEMO Study Group. Kidney Int 2000;58:346–352.
Wang AY, Lam CW, Wang M, et al: Circulating soluble vascular cell adhesion molecule 1: relationships with residual renal function, cardiac hypertrophy, and outcome of peritoneal dialysis patients. Am J Kidney Dis 2005;45:715–729.
Pecoits-Filho R, Heimburger O, Barany P, et al: Associations between circulating inflammatory markers and residual renal function in CRF patients. Am J Kidney Dis 2003;41:1212–1218.
Shin SK, Noh H, Kang SW, et al: Risk factors influencing the decline of residual renal function in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1999;19:138–142.
Cheung AK, Greene T, Leypoldt JK, et al: HEMO Study Group: Association between serum 2-microglobulin level and infectious mortality in hemodialysis patients. Clin J Am Soc Nephrol 2008;3:69–77.
Ross EA, Alza RE, Jadeja NN: Hospital resource utilization that occurs with, rather than because of, kidney failure in patients with end-stage renal disease. Clin J Am Soc Nephrol 2006;1:1234–1240.
Brener ZZ, Kotanko P, Thijssen S, et al: Clinical benefit of preserving residual renal function in dialysis patients: an update for clinicians. Am J Med Sci 2010;339:453–456.
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