Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic peritoneal dialysis.

Background: This study analysed children with end-stage renal disease treated with automated peritoneal dialysis (APD) in our centre to explore the risk factors associated with residual renal function (RRF) loss.

Methods: Children treated with APD as the initial renal replacement therapy regimen from January 2008 to December 2016 were included. All the children had a daily urine volume of ≥100 ml/m² when APD was initiated and a dialysis follow-up time of ≥12 months. A daily urine volume of <100 ml/m² after 12 months of APD treatment was defined as loss of RRF. Possible risk factors that may be associated with RRF loss were analysed.

Results: A total of 66 children were included in the study. After 12 months of APD treatment, the daily urine volume decreased by 377.45 ± 348.80 ml/m², the residual glomerular filtration rate decreased by 6.39 ± 3.69 ml/min/1.73 m² and 29 of the patients (43.9%) developed RRF loss. The higher risk of RRF loss after 1 year of APD treatment was most pronounced in patients with daily urine volume of ≤400 ml/m² before treatment, higher glucose exposure and higher ultrafiltration volume, while the lower risk of RRF loss was in patients with administration of diuretics. Each increase of 1 g/m²/day glucose exposure was associated with a 5% increase in RRF loss (odds ratio (OR) 1.05, p = 0.023) and each increase of 1 ml/m²/day ultrafiltration volume was associated with a 1% increase in RRF loss (OR 1.01, p = 0.013).

Conclusion: In children undergoing APD, the risk for loss of RRF is associated with low urine volume at the start of APD, high glucose loading and high peritoneal ultrafiltration volume, while preservation of RRF is associated with the usage of diuretics.