Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Clinical journal of the American Society of Nephrology: CJASN

Mi Jung Lee¹ 

[1] *Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnamsi, Korea;§Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea;‖Clinical Research Center for End-Stage Renal Disease, Daegu, Korea;†Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea;‡Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyangsi, Korea

关键词: dialysis;    end-stage renal disease;    glomerular filtration rate;    mortality;    residual kidney function;    urine volume;   

DOI  :  10.2215/CJN.05520516

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis.Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR β2-microglobulin were calculated from the equations using serum urea and creatinine and β2-microglobulin, respectively. The primary outcome was all-cause death.Results During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR β2-microglobulin data, eGFR β2-microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01).Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.

【 授权许可】

CC BY