Influencing Factors Of Residual Renal Function In Patients With Maintenance Peritoneal Dialysis

Background: Maintenance peritoneal dialysis is an important renal replacement therapy for patients with end-stage renal disease(ESRD).Currently,about 11% of dialysis patients around the world choose this therapy which protect residual renal function better than hemodialysis.Residual renal function decline is an important prognostic indicator of increased morbidity,mortality and decreased quality of life in patients treated maintenance peritoneal dialysis.Objective: To investigate the developmental trajectory of residual renal function in patients treated with maintenance peritoneal dialysis by using growth mixture modeling,and to explore the influencing factors of the decline rate of residual renal function.Methods: A total of 122 patients who undergoing peritoneal dialysis catheter implantation in the Department of Nephrology,The Third Xiangya Hospital from January 2018 to September 2021 were selected and followed up.General information,baseline data and follow-up data of the patients were collected.By using latent category analysis method,a 2-classification time free score increasing mixed model of dialysis month and residual renal function was established,and the patients were divided into groups according to the model classification.Then we explored the influencing factors of residual renal function decline rate.Results :(1)The absolute slope of RRF decline trajectory in patients with maintenance peritoneal dialysis reached the maximum at 1-3 months of dialysis age,after which the absolute slope gradually decreased.(2)According to GMM analysis,there was population heterogeneity in the RRF decline trajectory of maintenance peritoneal dialysis patients in this study,which could be divided into two categories.The descent rate of patients in one of the two categories category was significantly faster than the other one(one trajectory intercept of patients in the first category was6.811 and the slope was-1.738;The other trajectory intercept of the second type of patients was 5.877 and the slope was-2.635(p< 0.001).Therefore,the first group was called the RRF slow decline group(n=24,19.7%),and the second group was called the RRF rapid decline group(n=98,80.3%).(3)There were statistically significant differences in baseline systolic blood pressure,age,NRI,serum uric acid,binding ability of carbon dioxide,serum albumin,total protein,α1 microglobulin,brain natriuretic peptide,serum chlorine,serum κ light chain and serum iron between the two groups(p<0.05).(4)Binary logistic regression analysis showed that systolic blood pressure,age,NRI,serum uric acid and serum iron were independent influencing factors for rapid decline of RRF in patients treated with maintenance peritoneal dialysis.Patients with younger baseline age,higher systolic blood pressure,lower NRI score,higher nutritional risk,lower uric acid,and higher serum iron had increased risk of rapid decline in residual renal function.The normalized regression equation obtained from the model is: Logit(P)=-0.128×Age+0.055×SBP-0.013×UA+0.115×Fe-0.148×NRI+15.781.Conclusions :(1)RRF decline rate was the fastest in patients with maintenance peritoneal dialysis from 1 to 3 months of dialysis age,and then gradually slowed down.(2)There is population heterogeneity in the trajectory of RRF decline in patients treated with maintenance peritoneal dialysis,with one type of rapid decline and one type of slow decline.(3)The independent risk factors for rapid decline of RRF in patients with maintenance peritoneal dialysis were high baseline systolic blood pressure,young age,low NRI score,low serum uric acid,and high serum iron.