FP472INTERACTION OF RESIDUAL RENAL FUNCTION WITH THE EFFECT OF LOW NA SOLUTION ON BLOOD PRESSURE IN PERITONEAL DIALYSIS PATIENTS
Bibliographic record
Abstract
INTRODUCTION AND AIMS: With impaired renal function the net sodium (Na) balance as a result of sodium intake and sodium excretion is affected. Reduced sodium concentration in the peritoneal dialysis fluid (PDF) shall support the patient’s sodium and fluid balance. We analysed whether the level of residual renal function (RRF) in peritoneal dialysis (PD) patients has an impact on the effect of a sodium reduced PDF on blood pressure (BP). METHODS: This is a post-hoc analysis of a prospective, randomized, controlled double-blind clinical study on a low Na PDF (125 mmol/L Na) compared to a standard Na PDF (134 mmol/L Na) (Rutkowski et al. Am J Kidney Dis 2015). Patients in the per protocol population were divided into subgroups according to glomerular filtration rate (GFR) at baseline (≤ / > 6 ml/min/1.73 m2). Linear mixed models were used to analyse the interaction between GFR and the effect of the low Na PDF on BP and on further parameters related to the effect of sodium balance after 12 weeks of exposure following the initial analysis of this study. Estimation of the treatment effect was adjusted for baseline levels, country, GFR subgroup and the interaction between treatment and GFR subgroup; clustering of patients within study centres was accounted for by a random centre effect. Treatment effects on antihypertensive medication from baseline to week 12 were analysed by use of a Wilcoxon rank sum test. RESULTS: Out of the analysis population (82 pts), 52 had a GFR ≤ 6 ml/min/1.73 m2 and 30 a GFR > 6 ml/min/1.73 m2 at baseline. In the low GFR group the systolic BP was reduced with low Na PDF from 152±24 mmHg at baseline to 137±21 mmHg at week 12. Diastolic BP decreased from 90±16 mmHg to 83±11 mmHg. In the standard sodium group and in patients with high GFR in both treatment groups only minor changes were observed. For the low GFR subgroup, the treatment group difference in systolic BP at week 12 predicted by the linear mixed model was -16.9 (95% CI -27.16 to -6.64) mmHg. For diastolic BP, the difference was -7.92 (95% CI -12.62 to -1.43) mmHg, and after exclusion of two highly influential observations (sensitivity analysis), it was -4.58 (95% CI -10.07 to 0.91). In the high GFR group, no statistically significant difference of BP between the two solutions was observed. Antihypertensive medication increased slightly in all groups, to a lesser extent in the low Na PDF group. CONCLUSIONS: Sodium reduction in the PDF supports sodium and fluid balance (as shown in the primary study analysis - reduced serum Na, thirst, water intake, fluid output (urine and ultrafiltration)), likely generating a new steady state. The resulting reduction of BP in the low Na PDF group seems to be more effective in patients with no or low RRF than in patients with a residual capacity of renal sodium and fluid control.
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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 | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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".