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

Authors
 Mi Jung Lee  ;  Jung Tak Park  ;  Kyoung Sook Park  ;  Young Eun Kwon  ;  Hyung Jung Oh  ;  Tae-Hyun Yoo  ;  Yong-Lim Kim  ;  Yon Su Kim  ;  Chul Woo Yang  ;  Nam-Ho Kim  ;  Shin-Wook Kang  ;  Seung Hyeok Han 
Citation
 CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol.12(3) : 426-434, 2017 
Journal Title
 CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 
ISSN
 1555-9041 
Issue Date
2017
MeSH
Adult ; Aged ; Creatinine/blood ; Female ; Follow-Up Studies ; Glomerular Filtration Rate* ; Humans ; Kidney Failure, Chronic/physiopathology* ; Kidney Failure, Chronic/therapy* ; Kidney Failure, Chronic/urine ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Renal Dialysis ; Survival Rate ; Urea/blood ; Urine ; beta 2-Microglobulin/blood
Keywords
dialysis ; end-stage renal disease ; glomerular filtration rate ; mortality ; residual kidney function ; urine volume
Abstract
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.
Full Text
http://cjasn.asnjournals.org/content/12/3/426.long
DOI
10.2215/CJN.05520516
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kwon, Young Eun(권영은)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154512
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