The Effect of Dialyzer Membrane and Etiology of Kidney Disease on the Preservation of Residual Renal Function in Chronic Hemodialysis Patients

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Abstract
It is commonly believed that renal function rapidly decreases in the vast majority of chronic hemodialysis patients. Three hundred thirty-four patients starting chronic hemodialysis between 1/1/88 and 12/31/92 at six hemodialysis units were prospectively studied. Renal function was determined every 3 months by 68 hr urine collection expressed as weekly fraction urea clearance (L/L total body water/wk). glomerular filtration rate was calculated from the mean of the urea and creatinine clearance. After 3 years, glomerular filtration rate exceeded 4 ml/min in 14% of patients. For a thrice weekly dialysis schedule, it was assumed that a weekly fractional urea clearance of 3 L/L/wk is equal to a dialysis KT/V of 1 and patients need a minimum KT/V of 1.2 per treatment. After 3 years of chronic hemodialysis therapy, residual renal function was found to provide 15% of the dialysis requirement in 19% of patients and 30% of the dialysis requirements in 9% of patients. The occasional patient maintains sufficient residual renal function to provide over 40% of the dialysis requirement for over 4 years. In a retrospective analysis, patients treated only with Cupraphan membrane had a more rapid loss of renal function compared to those never treated with Cupraphan (Besnberg Corp., Germany). The majority of patients with polycystic kidney disease maintained a glomerular filtration rate greater than 2 ml/min for 4 years or longer.

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