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Review
. 2018 Jan;25(1):93-104.
doi: 10.1053/j.ackd.2017.09.001.

Measurement and Estimation of Residual Kidney Function in Patients on Dialysis

Tariq Shafi  1 , Andrew S Levey  2
Affiliations
Review

Measurement and Estimation of Residual Kidney Function in Patients on Dialysis

Tariq Shafi et al. Adv Chronic Kidney Dis. 2018 Jan.

Abstract

Residual kidney function (RKF) in patients on dialysis is strongly associated with survival and better quality of life. Assessment of kidney function underlies the management of patients with chronic kidney disease before dialysis initiation. However, methods to assess RKF after dialysis initiation are just now being refined. In this review, we discuss the definition of RKF and methods for measurement and estimation of RKF, highlighting the unique aspects of dialysis that impact these assessments.

Keywords: Cystatin C; Glomerular filtration rate; Residual kidney function; β-2 Microglobulin; β-Trace protein.

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Figures

Figure 1
Figure 1. Total Kidney Function – A New Conceptual Framework to Assess Kidney Replacement Therapies
A conceptual framework for assessing total kidney function in patients treated with kidney replacement therapies. The total function is a sum of residual kidney function plus the function provided by kidney replacement therapies. Total small solute clearance is a component of total kidney function and is the sum of small solute clearance by glomerular filtration, tubular secretion and kidney replacement therapy.
Figure 2
Figure 2. Extra-Renal Clearance of Iohexol
Comparison of clearance measurements in the Residual Kidney Function Study., (A) Scatterplot of 24-hour plasma clearance of iohexol (CL iohexol ) versus 24-hour urinary CL iohexol . Dashed lines and shaded areas represent the linear fit and confidence interval of the linear regression. (B) Plot of extrarenal CL iohexol (24-hour plasma CL iohexol- 24-hour urinary CL iohexol ) versus 24-hour urinary CL iohexol . Positive numbers represent overestimation of 24-hour urinary CL iohexol ; negative numbers, underestimation. Dashed line represents fit from a median quantile regression of the extrarenal CL iohexol on 24-hour urinary CL iohexol . Abbreviation: RMSE, root-mean-square error. From Shafi et al, reproduced with permission.
Figure 3
Figure 3. Diagnostic Accuracy for Estimating CLUREA ≥2 ml/min
Receiver operating characteristic (ROC) curves for the diagnostic accuracy of estimating equations by Shafi et al. in 826 dialysis patients of the NECOSAD. Sensitivity (%) is presented on the y-axis and 100-Specificity (%) is presented on the x-axis. Solid black line was calculated using the urea and creatinine equation, solid blue line the BTP equation, solid green line the B2M equation, solid red line the cystatin C equation, and orange line the BTP + B2M equation. B2M, β2 microglobulin; BTP, β-trace protein; CLUREA, urinary urea clearance (ml/min); CLUREA, CREAT, average of urinary urea and creatinine clearance (ml/min/1.73 m2); NECOSAD, Netherlands Cooperative Study on the Adequacy of Dialysis. From Shafi et al., modified with permission.
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References

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