The Relative Contribution of Residual Renal Function and Adequacy of Dialysis to Survival in Hemodialysis Patients
Bibliographic record
Abstract
A high delivered Kt/Vurea is advocated in the DOQI guidelines on hemodialyis (HD) adequacy. However, the contribution of residual renal function to overall urea clearance is neglected. We investigated the relative contribution of residual renal Kt/Vurea and delivered Kt/Vurea to patient survival. Furthermore, we investigated whether other characteristics of HD treatment may be independently associated with survival. The NECOSAD study is a prospective multi-center study and includes ESRD patients older than 18 years who start dialysis as their first renal replacement therapy. We analyzed the longitudinal data on residual renal function and dialysis adequacy of those patients who were treated with HD 3 months after the start (n = 704). The mean age was 62 years. The mean renal Kt/Vurea at 3 months was 0.7/week (SD: 0.6) and the mean dialysis Kt/Vurea at 3 months was 2.7/week (SD: 0.8). The 2-year survival was 73.5%. Both a higher weekly renal Kt/Vurea and a higher delivered Kt/Vurea were significantly and independently associated with a better survival (P values < 0.002). However, the effect of renal Kt/Vurea appeared to be significantly more pronounced (RR = 0.39 versus 0.72, P = 0.0014). The beneficial effect of delivered Kt/Vurea on survival became less and disappeared at increasing levels of renal Kt/Vurea. When the difference between the interdialytic weight gain and the ultrafiltration exceeded − 280 mL/week (i.e., an excess of ultrafiltration) an increase in mortality was found, independently of renal and delivered Kt/Vurea(RR = 1.94, P < 0.05). These data indicate that residual renal function is an important predictor of mortality in hemodialysis patients and that the delivered Kt/Vurea needs to be appropriately tuned to the renal Kt/Vurea. Furthermore, close monitoring of fluid balance is also an important measure of dialysis adequacy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".