Progression of Renal Failure on Hemodialysis Treatment

In 1976, Mitch et al. [1] showed by plotting sequential values of the reciprocal of serum creatinine concentration in mg/dl (Cr-1) against time, a linear decline in most chronic renal failure patients, from an average initial serum level of 2.6 mg/dl to an average value of 14.8 mg/dl. The rate of change of Cr-1 as an estimate of the rate of loss of renal function has been used to evaluate the influence of therapy on several nephropathies [2, 3]. Besides, in end-stage renal diseases on hemodialysis (HD) treatment the decline of the diuresis with time is a wellknown fact [4], more or less rapid depending on many factors. Serum predialysis levels of Cr and urea and residual diuresis were recorded in 106 patients on chronic HD, 3 × 4 h/week with cuprophan dialyzers of 1 or 1.4 m2 (depending only on ultrafiltration needs), at 0, 3, 6, 12, 18 and 24 months, from the start of HD treatment. The dialysis schedule was kept constant throughout the study and was not modified by clinical or biochemical parameters. Creatinine clearance at the start of HD was always below 5 ml/min. The distribution of etiologies was: glomerular, 31; interstitial, 10; vascular, 5; cystic disease, 5; 55 patients had undetermined etiology (only strictly proven etiologies were categorized). None of them were anephric. Mean serum Cr levels increased gradually with time (12.0–12.7–13.5–13.9–14.6–15.4 mg/dl), and correlation between Cr”1 vs. time was highly significant (r = 0.9729, p < O.OOl, fig. 1). Cr1 vs. time correlations were also found when patients were grouped by diseases: glomerular, r = 0.979, p < O.OOl; interstitial, r = 0.9498, p < O.Ol; vascular, r = 0.9498, p < 0.05; cystic disease, r = 0.8634, p < 0.05. However, only a few patients showed significant Cr^1 vs. time correlation when individually considered. We did not find urea vs. time or urea vs. Cr correlations. Mean n = 107 0.080 × = 110–1,376y r = 0.980 p < 0.001 0.075 0.070 0.065 0.060 J I 1