Prognostic value of residual urine volume, GFR by 24-hour urine collection, and egfr in patients receiving dialysis

Mi Jung Lee, Jung Tak Park, Kyoung Sook Park, Young Eun Kwon, Hyung Jung Oh, TaeHyun Yoo, Yong Lim Kim, Yon Su Kim, Chul Woo Yang, Nam Ho Kim, Shin-Wook Kang, SeungHyeok Han

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis. Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR b2 -microglobulin were calculated from the equations usingserum urea and creatinine and b2 -microglobulin, respectively. The primary outcome was all-cause death. Results During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR b2 -microglobulin data, eGFR b2 -microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01). Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.

Original languageEnglish
Pages (from-to)426-434
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number3
DOIs
Publication statusPublished - 2017 Jan 1

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Urine Specimen Collection
Residual Volume
Dialysis
Urine
Confidence Intervals
Urea
Creatinine
Kidney
Mortality
Korea
Cause of Death
Cohort Studies
Databases
Prospective Studies
Survival

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Lee, Mi Jung ; Park, Jung Tak ; Park, Kyoung Sook ; Kwon, Young Eun ; Oh, Hyung Jung ; Yoo, TaeHyun ; Kim, Yong Lim ; Kim, Yon Su ; Yang, Chul Woo ; Kim, Nam Ho ; Kang, Shin-Wook ; Han, SeungHyeok. / Prognostic value of residual urine volume, GFR by 24-hour urine collection, and egfr in patients receiving dialysis. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 3. pp. 426-434.
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abstract = "Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis. Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR b2 -microglobulin were calculated from the equations usingserum urea and creatinine and b2 -microglobulin, respectively. The primary outcome was all-cause death. Results During a mean follow-up of 42 months, 385 (19.8{\%}) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95{\%} confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95{\%} confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR b2 -microglobulin data, eGFR b2 -microglobulin (hazard ratio, 0.98; 95{\%} confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95{\%} confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95{\%} confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01). Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.",
author = "Lee, {Mi Jung} and Park, {Jung Tak} and Park, {Kyoung Sook} and Kwon, {Young Eun} and Oh, {Hyung Jung} and TaeHyun Yoo and Kim, {Yong Lim} and Kim, {Yon Su} and Yang, {Chul Woo} and Kim, {Nam Ho} and Shin-Wook Kang and SeungHyeok Han",
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Prognostic value of residual urine volume, GFR by 24-hour urine collection, and egfr in patients receiving dialysis. / Lee, Mi Jung; Park, Jung Tak; Park, Kyoung Sook; Kwon, Young Eun; Oh, Hyung Jung; Yoo, TaeHyun; Kim, Yong Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam Ho; Kang, Shin-Wook; Han, SeungHyeok.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 3, 01.01.2017, p. 426-434.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic value of residual urine volume, GFR by 24-hour urine collection, and egfr in patients receiving dialysis

AU - Lee, Mi Jung

AU - Park, Jung Tak

AU - Park, Kyoung Sook

AU - Kwon, Young Eun

AU - Oh, Hyung Jung

AU - Yoo, TaeHyun

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Kang, Shin-Wook

AU - Han, SeungHyeok

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis. Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR b2 -microglobulin were calculated from the equations usingserum urea and creatinine and b2 -microglobulin, respectively. The primary outcome was all-cause death. Results During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR b2 -microglobulin data, eGFR b2 -microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01). Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.

AB - Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis. Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR b2 -microglobulin were calculated from the equations usingserum urea and creatinine and b2 -microglobulin, respectively. The primary outcome was all-cause death. Results During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR b2 -microglobulin data, eGFR b2 -microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01). Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.

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