KP Index at the Initiation of Dialysis for Patients with End-stage Renal Disease

BACKGROUND: The time at which renal replacement therapy (RRT) is initiated in patients with end-stage renal disease (ESRD) has a great influence on the prognosis of the patient; however, there are currently no accurate guidelines for the initiation of RRT. Traditionally, nephrologists usually initiate RRT on the basis of the observation of the uremic symptoms and changes in the laboratory parameters, such as the serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest a weekly Kt/Vurea 2.0 and KP index 2.0 group, while there were no significant differences between the groups in the serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. Also, there was a statistically significant higher rate of incidence of patients starting RRT in the KP index 2.0 group. There was a significant correlation between the KP and other indices in all patients. When comparing the number of patients starting RRT, the weekly Kt/Vurea index demonstrated no significant differences between the 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5 groups, but the number of patients starting RRT in the 1.5 < KP index < 2.0 group was significantly higher than that in the 2.0 < KP index < 2.5 group. CONCLUSION: The KP index is considered a clinically useful index in ESRD patients for determining an appropriate time for the initiation of RRT. Also, the timing of the initiation of RRT should be fixed with regard to the various other indices and clinical features for a desirable prognosis of the patients. In addition, further studies will be required to determine accurate guidelines for an appropriate time for RRT initiation.

KP index at the timing of initiation of dialysis for patients with end-stage renal disease / 대한내과학회지

BACKGROUND: An initiating time of renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) has great influence on prognosis of the patients, however, there are currently no accurate guidelines for initiation of renal replacement therapy. Traditionally, nephrologists usually initiate RRT on the basis of observation of uremic symptoms and changes of laboratory parameters, such as serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest weekly Kt/Vurea 2.0 and KP index 2.0, while no significant differences between the groups were in serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. And the frequency of patients starting RRT was significantly higher in the group of KP index 2.0 in statistics. There was a significant correlation between KP index and other indices in all patients. In comparing and analyzing the number of patients starting RRT, weekly Kt/Vurea index did not demonstrate significant differences between two groups of 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5, but the frequency of patients in the group of 1.5 < KP index < 2.0 was significantly higher than that in the group of 2.0 < KP index < 2.5. CONCLUSION: It is considered that KP index is an index clinically useful for ESRD patients to determine an appropriate timing for the initiation of RRT, and that the timing should be fixed with regard for other various indices and clinical features for advisable prognosis of the patients. In addition, accurate guideline to determine such an appropriate time needs to be suggested by further new studies.

Evaluation of Residual Renal Function of Chronic Renal Failure at the Initiation of Dialysis / 대한신장학회잡지

The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. Decreased residual renal function and malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, to investigate the residual renal function and nutritional parameters of chronic renal failure patients at the initiation of dialysis, 103 patients with chronic renal failure patients were studied. The residual renal function(estimated GFR) was ascertained by measuring simultaneously the 24-h creatinine and urea clearances and averaging the two values and Krt/V. Nutritional parameters were ascertained by measuring the nPNA, %LBM and serum albumin. The mean estimated GFR was 5.97+/-2.88ml/min, the mean weekly Krt/V was 1.24+/-0.80, the mean %LBM was 61.66+/-22.41 and the mean nPNA was 0.89+/-0.30 g/day/kg. We knew that the time of initiation of dialysis, which was based on the manifestation of symptoms of certain patients in conjunction with selected laboratories indices, was delayed than that of NKF- DOQI recommendation. This study suggests that the timely initiation of dialysis is determined by not clinical symptoms and signs but estimated GFR, krt/V and nPNA.

Clinical features of ESRD patients at the initiation of dialysis / 대한내과학회지

BACKGROUND: Up to now, no study have been reported about clinical features of ESRD patients at the initiation of dialysis and their outcomes in Korea. We studied the clinical features and survival predictors of ESRD patients at the initiation of dialysis therapy and their outcomes and we tried to identify the optimal point of starting dialysis therapy according to age, underlying disease, and other variables. METHODS: We studied retrospectively clinical and laboratory variables of initiation in 364 patients who started dialysis therapy first at Korea University Guro hospital from 1987 to 1997. We divided patients into 3 groups by age, into 2 groups by underlying renal disease(DM vs. nonDM) and compared the above variables between 3 or 2 groups. We evaluated the outcome(alive vs. death) in 258 patients whoes outcomes were identified. We identified the poor survival predictors of outcome according to alive / death group, and analized the relative risk of death according to level of serum creatinine (reference: 12.5-15.0 mg/dL) and serum albumin (reference: 4.0-4.5 g/dL). RESULTS: 1) The distribution of patients by age, young age group, middle age group, old age group were 135, 140 and 89. Those of patients by underlying renal disease, DM and nonDM were 80 and 284 respectively. 2) The most common underlying renal disease of young age group was chronic glomerulonephritis but that of old age group was diabetes mellitus. In old age group, levels of BUN, serum creatinine, and serum phosphate were lower than those in young age group(P<0.001). In old age group, the indication of dialysis tended toward relative(p=0.098) and early referral was more common than in young age group. 3) DM group was older and more early referred than nonDM group. In DM group, blood cholesterol level was higher, but level of BUN, serum creatinine, albumin, phosphate and uric acid were lower than those in nonDM group. 4) In 258 patients whose outcomes were identified, elderly and DM had poorer outcomes in the respect of mortality and survival by Kaplan-Meier survival analysis method. In the comparison of death group and alive group, death group was older and had more DM as underlying renal disease and lower level of serum creatinine than alive group. 5) Relaive risk of death was higher in lower concentrations comparing to reference level of albumin and creatinine. CONCLUSION: Old age, DM as underlying renal disease, hypoalbuminemia and hypocreatinemia were poor survival predictors. Then close observation and follow-up are warranted in patients with old age, DM, hypoalbuminemia, and hypocreatinemia. For more favorable prognosis in ESRD patients, early initiation of dialysis must be considered in patients who have these characteristics.