Effects Of Dietary Protein Intake And Dialysis Frequency On The Preservation Of Residual Kidney Function In MHD Patients

Objectives:Residual kidney function is very important for maintenance hemodialysis patients to keep the survival rate and nutritional status, to improve mineral metabolism, hormone secretion and so on. In recent years, protecting the residual kidney function in hemodialysis patients gained attention, but the exact method is not clear. Low protein diet helps to protect the residual renal function, has been confirmed in CKD patients and peritoneal dialysis patients, but there is no related reports in hemodialysis patients. In addition, it remains controversial about whether hemodialysis frequency will impact of residual rkidney function. The purpose of this study was to further investigate the effect of protein intake and the initial treatment of hemodialysis frequency on residual renal function decline in hemodialysis patients.Methods:The first part is a cross-sectional study, surveyed of88hemodialysis patients with different protein intake (<1.0, g/kg/d, g/kg/d,1.0-1.2≥1.2g/kg/d) and the relationship between nutrition and metabolism, residual kidney function and clinical outcome. The second part using the same cross-sectional study, survey of85hemodialysis patients with different dialysis frequency in the initial6months treatment (2times a week or3times a week) for the effect of residual renal function, dialysis adequacy and clinical prognosis. The third part is retrospective study, analysis initial dialysis frequency within a year in new hemodialysis patients from2008January2011October effect on residual kidney function, and look for independent predictors of residual renal function loss.Using conventional methods to detect the biochemical indicators, urine output<200ml/d is defined as the loss of residual renal function, calculated dietary intake in patients with the keto diet calculator, using the t test, chi-square test, univariate analysis, logistic regression analysis for statistical analysis.Results:The first part of the study found that56.8%of hemodialysis patients daily protein intake (DPI) between1.0g/kg. d and1.2g/kg. d. some of nutritional, biochemical indicators in these part of patients are better than the low-protein group (<1.0g/kg. d to) and high protein intake group (>1.2g/kg· d), despite the proportion of the loss residual kidney function patients in each group was no significant difference, the time of loss residual kidney function in1.0-1.2g/kg. d DPI group (44.73±33.10m), is significantly higher than the low-protein group (15.20±16.74m) and high protein group (10.25±13.84M), a statistically significant difference.The second part of the study confirmed that the initial dialysis treatment-2times per week over6months (the low frequency treatment group) compared with the conventional treatment group, in the various aspects of dialysis adequacy, cardiovascular complications, hospitalization rates and biochemical indicators are no significant differences, but the proportion of patients having residual renal function in the low-frequency treatment group (40%) was significantly higher than the conventional treatment group (12%), and the average lost time in patients without residual kidney function is significantly longer (37.06±33.18m than23.35±17.69m).The third part of the study,39.58%of the new hemodialysis patients lose residual kidney function in the first year, the average loss time was7.63±4.51m. Multivariate logistic regression analysis showed that the weekly frequency of dialysis (OR7.2, P=0.039), male (OR0.08, P=0.018), dialysis hypotension frequency (OR2.51, P=0.036) and URR (OR0.85, P=0.047) are independent predictors in the decline in residual renal function, But protein intake, nutrition and metabolism, drug applications is not related.Conclusions:New hemodialysis patients are at high risk of loss residual renal function during the first year, the risk factors leading to a decrease in residual renal function are female, high frequency of dialysis and intradialytic hypotension, the right dialysis frequency may be the key to protect residual kidney function in new hemodialysis patients. Daily protein intake of1.0-1.2g/kg. d contributes to maintain nutritional and metabolic state better, but has no direct effect on the protection of residual kidney function.