The usual perception of anyone on chronic dialysis is that their kidneys are dead and crossed the rainbow bridge – called “End-Stage Renal Disease (ESRD) – so it’s now for kidneys to be a medical punching bag and not worry about renal damage anymore.
Ugh ! not so fast ! some dialysis patient still make urine – they are said to have Residual Renal Function (RRF) or Residual Kidney Function (RKF). Ample evidence shows that hemodialyis patients with RRF have much lower mortality rates compared to those without – for example, this large study showed how dialysis patients with RRF at year after dialysis initiation had a 30% lower risk of all-cause mortality and a 31% lower risk of cardiovascular deaths than those without RRF, here’s another large study. The logic is simple – If kidneys are still making some urine, they are helping the patient with fluid & toxin clearance slowly but continuously on non-dialysis days, so they need lower intensity dialysis and fluid removal (ultrafiltration), which is less taxing to their bodies AND 2. Making urine for excretion of toxis and manaing electrolytes is not the only thing kidneys, they also have hormonal function (Vit. D, Erythropoetin) and blood pressure assistance function.
This paper outlines steps to preserve RRF, such as:
– Avoiding Nephrotoxins like IV contrast dyes, NSAIDs, etc. if possible.
– Rigorous blood pressure control including avoiding hypotension
– Personalizing dialysis plan – Using Incremental less frequent hemdialysis or peritoneal dialysis, instead of going full throttle to a three times hemodialysis scehdule, etc
💡 So, the next time you handle a dialysis patient – it’s good to know if they are still making urine. If they still are, it’s worth protecting what’s left.
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