Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
PLoS One. 2020 Nov 16;15(11):e0242254. doi: 10.1371/journal.pone.0242254. eCollection 2020.
Residual kidney function (RKF) is associated with improved survival and quality of life in dialysis patients. Previous studies have suggested that initiation of peritoneal dialysis (PD) may slow RKF decline compared to the pre-dialysis period. We sought to evaluate the association between PD initiation and RKF decline in the Initiating Dialysis Early And Late (IDEAL) trial.
In this post hoc analysis of the IDEAL randomized controlled trial, PD participants were included if results from 24-hour urine collections had been recorded within 30 days of dialysis initiation, and at least one value pre- and one value post-dialysis commencement were available. The primary outcome was slope of RKF decline, calculated as mean of urinary creatinine and urea clearances. Secondary outcomes included slope of urine volume decline and time from PD initiation to anuria.
The study included 151 participants (79 early start, 72 late start). The slope of RKF decline was slower after PD initiation (-2.69±0.18mL/min/1.73m2/yr) compared to before PD (-4.09±0.33mL/min/1.73m2/yr; change in slope +1.19 mL/min/1.73m2/yr, 95%CI 0.48-1.90, p<0.001). In contrast, urine volume decline was faster after PD commencement (-0.74±0.05 L/yr) compared to beforehand (-0.57±0.06L/yr; change in slope -0.18L/yr, 95%CI -0.34--0.01, p = 0.04). No differences were observed between the early- and late-start groups with respect to RKF decline, urine volume decline or time to anuria.
Initiation of PD was associated with a slower decline of RKF compared to the pre-dialysis period.
残余肾功能（RKF）与透析患者的生存和生活质量改善相关。既往研究提示与透析前阶段相比，起始腹膜透析（PD）可能延缓 RKF 下降。我们旨在评估 IDEAL 试验中 PD 起始与 RKF 下降之间的关联。
本 IDEAL 随机对照试验的事后分析中，如果在透析起始后 30 天内记录了 24 小时尿液收集结果，并且起始透析前和起始透析后至少有一个值可用，则纳入 PD 参与者。主要结局为 RKF 下降斜率，计算方法为尿肌酐和尿素清除率的平均值。次要结局包括尿量下降斜率和从 PD 起始到无尿的时间。
研究纳入 151 名参与者（79 名早起始，72 名晚起始）。与起始 PD 前（-4.09±0.33mL/min/1.73m2/yr）相比，起始 PD 后 RKF 下降斜率更慢（-2.69±0.18mL/min/1.73m2/yr/yr；斜率变化+1.19mL/min/1.73m2/yr，95%CI 0.48-1.90，p<0.001）。相比之下，起始 PD 后尿量下降更快（-0.74±0.05 L/yr），而起始 PD 前则更慢（-0.57±0.06L/yr；斜率变化-0.18L/yr，95%CI -0.34--0.01，p = 0.04）。早起始和晚起始组在 RKF 下降、尿量下降或无尿时间方面无差异。
与透析前阶段相比，起始 PD 与 RKF 下降速度较慢相关。
