Kidney Week

Abstract: TH-PO411

Estimating Residual Kidney Function in Dialysis Patients Without Urine Collection

Session Information

• Dialysis: Peritoneal Dialysis - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Steubl, Dominik, Tufts Medical Center, Boston, United States

Dominik Steubl,

• Fan, Li, Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health; Guangdong Provincial Key Laboratory of Nephrology, , Guangzhou, China

Li Fan,

• Inker, Lesley, Tufts Medical Center, Boston, Massachusetts, United States

Lesley Inker,

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart,

• Dekker, Friedo W., Leiden University Medical Center, Leiden, Netherlands

Friedo W. Dekker,

• Karger, Amy B., University of Minnesota, Minneapolis, Minnesota, United States

Amy B. Karger,

• Eckfeldt, John H., University of Minnesota Medical School, Minneapolis, Minnesota, United States

John H. Eckfeldt,

• Zhang, Hao, The Third Xiangya Hospital of Central South University, Changsha, HUnan, China

Hao Zhang,

• Hu, Jing, The third Xiangya hospital of Central South Univercity, Changsha, China

Jing Hu,

• Liao, Yunhua, The First Affiliated Hospital of Guangxi Medical University, Nanning, China

Yunhua Liao,

• Shafi, Tariq, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Tariq Shafi,

• Chen, Wei, The First Affiliated Hospital, Sun Yat-sen University,, Guangzhou, China

Wei Chen,

• Yu, Xueqing, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

Xueqing Yu,

• Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States

Andrew S. Levey,

Background

Measurement of RKF is recommended for adjustment of the dialysis prescription, but timed urine collections are difficult and prone to errors. Few equations to estimate RKF in dialysis patients using serum concentrations of low molecular weight proteins (LMWP) have been externally validated (Shafi T et al, Kidney Int 2016).

Methods

We developed RKF estimating equations using linear regression analysis in 823 peritoneal dialysis patients in the Guangzhou PD Study. The reference tests were measured clearance of urea nitrogen (UN) (mCl_UN, ml/min) and average clearance of UN and creatinine (mCl_UN-cr, ml/min/1.73 m²). The index tests were estimated clearance (eCl) using UN and creatinine (eCl_UN-cr), beta-trace-protein (eCl_BTP), beta-2-microglobulin (eCl_B2M), cystatin C (eCl_cys) and combinations. Equations were then externally validated in 826 hemo- and peritoneal dialysis patients in the NECOSAD study and also compared to published validated equations.

Results

In external validation, bias was within ±1.0 (Table). Precision and accuracy were significantly better for eCl_BTP, eCl_B2M and eCl_BTP-B2M than eCl_UN-cr. The area-under-the-curve for predicting mCl_UN >2.0 ml/min for eCl_B2M and eCl_BTP-B2M was 0.853 and 0.848, respectively (Figure). Results were similar to other validated equations.

Conclusion

These results confirm the validity and extend the generalizability of estimation of RKF from serum concentrations of LMWPs without urine collection.

Funding

• Commercial Support – Siemens, Dialysis Clinic Inc.