PubMed · 13064749
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E M TOMLIN, T N QUILTER. 1953. Reflex anuria.. https://pubmed.ncbi.nlm.nih.gov/13064749/
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BACKGROUND: It remains unknown whether results of survival studies in anuric patients can be extrapolated to those who still have significant urine output. It is possible that after a prolonged period on dialysis, anuric patients are qualitatively different from patients with residual renal function. METHODS: We performed a retrospective review to study the cause of death of 296 peritoneal dialysis patients of our centre over a 7 year period, and compared the mortality and distribution of cause of death between patients with and without residual renal function. RESULTS: One hundred and forty-two cases (48.0%) died of vascular diseases, 82 cases (27.7%) died of infections and 72 cases (24.3%) died of other causes. Anuric patients had a higher overall mortality rate than non-anuric patients (14.9 vs 9.9%, P=0.0005), and the difference was almost completely attributed to the difference in mortality from vascular diseases (8.0 vs 4.1%, P<0.0001). Vascular disease was a more common cause of death in anuric patients than those with residual renal function (55.3 vs 40.8%, P=0.011). The difference was largely explained by the higher prevalence of sudden cardiac death in anuric patients (39 in 149 vs 19 in 147 cases). Patients without pre-existing cardiovascular disease more commonly died of vascular disease after they became anuric (47.4 vs 34.0%, P=0.017). The difference could not be explained by the longer duration of dialysis in anuric patients because there was no significant change in the distribution of cause of death with time on dialysis (chi-square test, P=0.341). CONCLUSIONS: Our observation suggests that peritoneal dialysis patients with and without residual renal function are qualitatively different. Studies on peritoneal dialysis adequacy and survival in anuric patients should only be extrapolated to the general dialysis population with caution.
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INTRODUCTION: Dialysis efficacy affects the outcome of dialysis patient. Increasing the dialysis dose is related with mortality decrease. The measure of hemodialysis dose and single dialysis urea removal is expressed as Kt/V value (K is blood urea clearance, t is dialysis treatment duration, and V is volume of urea distribution). Hemodialysis dose can be prescribed from the urea kinetic model (UKM). Calculation of single dialysis delivered Kt/V is based on predialysis and postdialysis urea concentrations. The aim of the study was to demonstrate the influence of body mass and gender on the delivered and prescribed dialysis dose. PATIENTS AND METHODS: Seventy-five bicarbonate low-flux hemodialysis sessions in 25 anuric subjects (13 males and 12 females) treated with chronic hemodialysis for at least one year were analyzed. For every single hemodialysis session, delivered Kt/V (Daugirdas and Keshaviah) and prescribed Kt/V (according to UKM) were calculated. RESULTS: Hemodialysis sessions in females were more efficient than in male subjects (delivered Kt/V Daugirdas 1.18 +/- 0.24 vs. *1.04 +/- 0.21, p = 0.008 and prescribed Kt/V UKM 1.42 +/- 0.16 vs. 0.92 +/- 0.11, p < 0.001). According to body weight, hemodialysis sessions were more efficient in < 70 kg than in > 70-kg subjects (delivered Kt/V Daugirdas 1.24 +/- 0.24 vs. 1.01 +/- 0.18, p < 0.001 and prescribed Kt/V UKM 1.36 +/- 0.23 vs. 1.00 +/- 0.22, p < 0.001). Body mass of dialyzed subject and delivered/prescribed dialysis dose showed negative correlation (r = -0.45, p < 0.001/r = -0.69, p < 0.001). Male gender and delivered/prescribed dialysis dose also yielded negative correlation (r = -0.31, p = 0.008/r = -0.885, p < 0.001). CONCLUSION: The results of the study demonstrated negligence in prescribing hemodialysis dose in male and heavy subjects. Consequently, in these subjects the single delivered dialysis dose was inadequate. We recommend careful dialysis dose prescribing and frequent measurement of the delivered dialysis dose in heavy males on chronic hemodialysis therapy. In extreme cases, on-line monitors could be a useful tool for real time delivered dialysis dose measurement, so the prescribed dialysis parameters could be revised during the treatment (especially useful would be prolongation of the dialysis session).