Mokoli Vieux Momeme, Sumaili Ernest Kiswaya, Lepira François Bompeka, Mbutiwi Fiston Ikwa Ndol, Makulo Jean Robert Rissassy, Bukabau Justine Busanga, Izeidi Patrick Parmba, Luse Jeannine Losa, Mukendi Stéphane Kalambay, Mashinda Désiré Kulimba, Nseka Nazaire Mangani
Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Hemodialysis Unit of Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo.
BMC Nephrol. 2018 Mar 20;19(1):68. doi: 10.1186/s12882-018-0865-x.
Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa.
This historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period. We compared the baseline characteristics of the patients according to their initial RUV (≤ 500 ml/day vs > 500 ml/day) using Student's t, Mann-Whitney U and Chi2 tests. Linear mixed-effects models were used to search for predictors of decreased RUV by adding potentially predictive baseline covariates of the evolution of RUV to the effect of time: age, sex, diabetes mellitus, hypertension, diastolic blood pressure, diuretics, angiotensin conversion enzyme inhibitors (ACEI), angiotensin receptor blockers, hypovolemia, chronic tubulointerstitial nephropathy, left ventricular hypertrophy and initial hemodialysis characteristic. A value of p < 0.05 was considered the threshold of statistical significance.
The majority of hemodialysis patients were male (68.8%, sex ratio 2.2), with a mean age of 52.5 ± 12.3 years. The population's RUV decreased with time, but with a slight deceleration. The mean RUV values were 680 ± 537 ml/day, 558 ± 442 ml/day and 499 ± 475 ml/day, respectively, at the initiation of HD and at 6 and 12 months later. The use of ACEI at the initiation of HD (beta coefficient 219.5, p < 0.001) and the presence of chronic tubulointerstitial nephropathy (beta coefficient 291.8, p = 0.007) were significantly associated with RUV preservation over time. In contrast, the presence of left ventricular hypertrophy at the initiation of HD was significantly associated with decreased RUV over time (beta coefficient - 133.9, p = 0.029).
Among incident hemodialysis patients, the use of ACEI, the presence of chronic tubulointerstitial nephropathy and reduced left ventricular hypertrophy are associated with greater RUV preservation in the first year of dialysis.
残余尿量（RUV）减少与血液透析（HD）患者较高的死亡率相关。然而，在撒哈拉以南非洲接受血液透析的患者中，很少有研究对RUV进行过检查。本研究的目的是确定金沙萨初治血液透析患者中RUV的预测因素。
这项历史性队列研究纳入了2007年1月至2013年7月期间在金沙萨的两个血液透析中心接受血液透析的250例终末期肾病（ESRD）患者。在HD开始时以及6个月和12个月后的透析间期收集24小时的RUV。我们使用学生t检验、曼-惠特尼U检验和卡方检验，根据患者的初始RUV（≤500 ml/天与>500 ml/天）比较患者的基线特征。通过将RUV演变的潜在预测性基线协变量添加到时间效应中，使用线性混合效应模型来寻找RUV降低的预测因素：年龄、性别、糖尿病、高血压、舒张压、利尿剂、血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂、血容量不足、慢性肾小管间质性肾病、左心室肥厚和初始血液透析特征。p<0.05的值被认为具有统计学意义。
大多数血液透析患者为男性（68.8%，性别比2.2），平均年龄为52.5±12.3岁。人群的RUV随时间下降，但下降速度略有减慢。HD开始时以及6个月和12个月后的平均RUV值分别为680±537 ml/天、558±442 ml/天和499±475 ml/天。HD开始时使用ACEI（β系数219.5，p<0.001）和存在慢性肾小管间质性肾病（β系数29１.8，p=0.007）与RUV随时间的保留显著相关。相比之下，HD开始时存在左心室肥厚与RUV随时间下降显著相关（β系数-133.9，p=0.029）。
在初治血液透析患者中，使用ACEI、存在慢性肾小管间质性肾病以及左心室肥厚减轻与透析第一年RUV的更大保留相关。
