Department of Nephrology, Room F03.223, University Medical Center-Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Clin J Am Soc Nephrol. 2011 Feb;6(2):281-9. doi: 10.2215/CJN.04480510. Epub 2010 Oct 28.
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.
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.
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.
人们越来越意识到残余肾功能（RRF）对血液透析（HD）患者有益。本研究旨在探讨 GFR 表示的 RRF 在慢性 HD 患者的磷酸盐和贫血管理中的作用。
设计、地点、参与者和测量：对来自 Convective Transport Study（CONTRAST）的 552 例连续患者的基线数据进行了分析。根据 GFR 程度，将尿量≥100ml/24h（n=295）的患者分为三组，并与无尿患者（即尿量<100ml/24h，n=274）进行比较。使用多变量回归模型分析 GFR 与血清磷酸盐和促红细胞生成素刺激剂（ESA）指数（每周 ESA 剂量除以体重除以红细胞压积）之间的关系。
在上三分位组（GFR>4.13ml/min/1.73m2）中，68%的患者血清磷酸盐水平在 3.5 至 5.5mg/dl 之间，而无尿患者的这一比例为 46%，尽管磷酸盐结合剂的处方较低。平均血红蛋白水平为 11.9±1.2g/dl，各 GFR 组之间无差异。上三分位组的 ESA 指数比无尿患者低 31%。调整患者特征后，与无尿患者相比，上三分位组患者的血清磷酸盐水平和 ESA 指数显著降低。
本研究表明，RRF 与 HD 患者的磷酸盐和贫血控制改善密切相关。在 HD 患者中努力保留 RRF 可以改善预后，应予以鼓励。
