Preserving Residual Renal Function In Dialysis Patients

Preservation of kidney function is given much thought, in general, by both patients and providers as a patient struggles through the stages of Chronic Kidney Disease. Once a patient begins dialysis, a fairly common misconception is that dialysis completely "takes over" the function of the faltering kidneys and thought of preserving the function left is "superfluous". Nothing could be further from the truth. Preservation of residual renal function, or the contribution of the native kidneys once dialysis has begun, has been shown to improve circulating levels of inflammatory markers, middle molecule clearance, blood pressure, and other markers of dialysis adequacy. It also aids in the management of fluid, and can decrease the dialysis time needed both in hemodialysis and in Peritoneal Dialysis. A patient, newly on PD and making a significant amount of urine still, told us in clinic this morning that her general physician had told her she could return to the arthritis medication that had originally contributed to her kidney failure because "It can't hurt you now". Completely untrue. It is important for patients to be instructed that as long as they continue to produce urine, care to protect the kidneys by avoiding nephrotoxic agents should be undertaken-both medications and during diagnostic testing that may use contrast. This is especially common in the patients undergoing workup for kidney transplantation at the initiation of dialysis. If you are uncertain about a medication, or a medication dosage, or the effect of a diagnostic test-call your kidney team and ask. Now you understand why we ask if you are making urine as we round or see you in PD clinic, or why we may give a diuretic even though you feel the effect of the medication isn't dramatic. Every little bit helps. And we believe if you understand why we ask you to do things, you are much more likely to consistently do them. Teamwork.