COMPARISON OF DIFFERENT TECHNIQUES OF DETERMINING THE RESIDUAL FUNCTION OF THE KIDNEYS

THE AIM of the work was to compare different techniques of determining the residual renal function for the establishment of the most reliable criterion of selection of patients for beginning the substitution renal therapy (SRT). PATIENTS AND METHODS. A retrospective comparative analysis of three means of determining the residual renal function was made in 208 patients with the terminal stage of chronic renal failure in three dialysis centers of St.Petersburg at the period from 1986 through 2004. RESULTS. It was found that the values of creatinine clearance determined by two methods (with the Rehberg test and by the formula CockcroftGault) differed from the values of the glomerular filtration rate (GFR) calculated by MDRD formula. The index of survival of dialysis patients was used in order to determine the prospective value of the calculation methods. Mathematically it was confirmed that among the methods of determining the excretory function of the kidneys the GFR indices calculated by the MDRD formula were the only significant predictor of lethality independent of stratification. CONCLUSION. It was convincingly shown that the determination of the residual renal function values calculated by GFR using the modified MDRD formula allows the development of common criteria for correct selection of patients for the beginning of dialysis. The values calculated by MDRD formula are the only ones from the investigated indices of the residual function of the kidneys at the start of SRT influencing the survival of dialysis patients.

1. Завада Э. Начало диализа. Руководство по диализу. Ред. Даугирдас Д, Блейк П, Инг Т. Перевод Денисова АЮ, Шило ВЮ. Москва 2003: 2331

2. Николаев АЮ, Милованов ЮС. Лечение почечной не достаточности. СПб 1999: 91

3. Рябов СИ. Лечение хронической почечной недостаточности. Врачебные ведомости 1999; 7 (1): 2933

4. Шостка ГД, Земченков АЮ, Команденко МС. Своевременное начало диализа – основа успешной терапии конечной стадии почечной недостаточности. Врачебные ведомости 1999; 2: 4047

5. Ермоленко ВМ. Хроническая почечная недостаточность. Нефрология. Ред. Тареева ИЕ, М. 2000: 619

6. NKF K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (2) [Suppl. 1]: S1S266

7. Земченков АЮ, Томилина НА. «К/ДОКИ» обращается к истокам хронической почечной недостаточности. Нефро логия и диализ 2004; 6 (3): 204220

8. European best practice guidelines for haemodialysis (Part 1). Section I. Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant 2002; 17 [Suppl 7]: 715

9. Команденко МС, Шостка ГД. Современная тактика начала диализной терапии. Врачебные ведомости 2001; 3 (2): 160168

10. Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31

11. Бикбов БТ, Кирхман ВВ, Ушакова АИ, Камшилова НИ, Томилина НА. Предикторы летального исхода у больных на гемодиализе. Нефрология и диализ 2004; 6 (2): 154 163

12. Методические указания № 2004/38. Ведение больных сахарным диабетом с терминальной хронической почечной недостаточностью на диализе. М, 2004: 17

13. Bonomini V, Albertazzi A, Vangelista P et al. Residual renal function and effective rehabilitation in chronic dialysis. Nephron 1976; 16: 89

14. Levy J, Morgan J, Brown E. Assessment of renal function at/near end stage: creatinine clearance. Oxford Handbook of Dialysis 2003; 1819

15. Томилина НА. Объединенный конгресс «Нефрология и диализ сегодня» Новосибирск 15 – 17 сентября 2003

16. Шостка ГД. Медикосоциальная экспертиза при внутренних болезнях. Хроническая почечная недостаточность. Ред. Шварцман ЗД. СПб, 2003; 208213