Study on the protection of residual renal function in New hemodialysis patients with restricted dehydration

Objective To observe the effect of restricted dehydration (RD) on residual renal function in new hemodialysis patients. Methods A total of 96 new hemodialysis patients undergoing hemodialysis in Center of Blood Purification of Tangdu Hospital,Air Force Military Medical University during January 2016 to January 2017 were enrolled in this study, with an average age of (47.78±11.21). At the first time of dialysis, the patients were randomly divided into restricted dehydration (RD) group and unrestricted dehydration (UD) group. For all the patients, the urine volume was kept to be ≥ 1 000 mL/d, and the blood pressure was controlled below 150/90 mmHg. All the patients were dialyzed three times a week. The daily urine volume and creatinine clearance rate were documented every 3 months. Renal function, routine blood test, electrolyte and other biochemical indicators were reexamined before dialysis every 3 months. Cardiothoracic ratio was calculated every 6 months. The primary endpoint included refractory hypertension, edema, cardio-cerebrovascular accident, severe anemia and death, and the secondary endpoint was oliguria. All the patients were followed up for 1 year. Results At the end of follow-up, 6 patients in the RD group reached the secondary end point (oliguria), and 8 patients reached the primary end points (6 patients with hypertension, 2 patients with edema and heart failure). In the UD group, 16 patients reached secondary end points (oliguria), and 2 underwent kidney transplantation. At the end of follow-up, compared with the UD group, the urine volume in the RD group was (778±309 mL)vs(471±212 mL), with P<0.05 indicating statistically significant difference;and the hemoglobin compliance rate was 78.79% vs 77.45%, with P>0.05 indicating no statistically significant difference. The albumin compliance rate was 81.27% vs 82.34%, with the P value >0.05 indicating no statistically significant difference between the two groups. Conclusions Restrictive dehydration can preserve the residual renal function of new hemodialysis patients, but it is necessary to individualize the treatment according to the specific medical conditions and patients' conditions in clinical work. Unilateral restrictive dehydration is not suitable for all new hemodialysis patients.