Vilar Enric, Farrington Ken
Semin Dial. 2011 Sep-Oct;24(5):487-94. doi: 10.1111/j.1525-139X.2011.00968.x.
Residual renal function (RRF) is well recognized as an important marker of outcomes in peritoneal dialysis (PD), and contributes vitally to solute clearance. Recently, its importance in hemodialysis (HD) has emerged with evidence that it is strongly associated with improved outcomes. The presence of RRF is associated with improved nutrition, reduced erythropoetin requirements, better potassium clearance, and improved quality of life. Retrospective and observational evidence is now available, which suggests that the presence of RRF is independently associated with survival and that this benefit goes beyond what is expected simply from augmentation of small solute clearance. Preservation of RRF is now considered by many to be an important aspect of dialysis strategy. Evidence in favor of one modality over another for preservation of RRF is conflicting, as are the potential benefits of biocompatible fluids in PD. In HD, the evidence in favor of biocompatible membranes is stronger. Emerging evidence is broadly in favor of angiotensin converting enzyme inhibitors for preservation of RRF. Diuretics appear to have a neutral effect. The complexities and practical difficulties in measurement of RRF have resulted in this important parameter being largely ignored in HD. Novel markers of renal function may provide alternative, simple methods of estimating RRF, which may remove the need for urine collections and simplify its measurement.
残余肾功能（RRF）是腹膜透析（PD）预后的一个重要指标，对溶质清除起着至关重要的作用。最近，其在血液透析（HD）中的重要性也逐渐显现，有证据表明它与改善预后密切相关。RRF的存在与营养状况改善、促红细胞生成素需求减少、钾清除更好以及生活质量提高有关。现在有回顾性和观察性证据表明，RRF的存在与生存率独立相关，而且这种益处不仅仅是通过增加小分子溶质清除所预期的。现在许多人认为保留RRF是透析策略的一个重要方面。关于哪种透析方式更有利于保留RRF的证据相互矛盾，腹膜透析中生物相容性液体的潜在益处也是如此。在血液透析中，支持生物相容性膜的证据更强。新出现的证据广泛支持使用血管紧张素转换酶抑制剂来保留RRF。利尿剂似乎具有中性作用。RRF测量的复杂性和实际困难导致这个重要参数在血液透析中基本被忽视。新型肾功能标志物可能提供替代的、简单的估计RRF的方法，这可能无需收集尿液并简化其测量。
