Why is residual kidney function important in patients with PD?
RKF is strongly associated with a survival advantage for patients receiving both peritoneal and HD. Postulated reasons for this association include better
- • Removal of phosphate
- • Removal of middle molecular and protein-bound wastes
- • Salt and water balance
- • Removal of inflammatory mediators
Therefore it is important to protect RKF in patients receiving dialysis. PD is superior to HD in preserving RKF. This is probably related to the hemodynamic factors associated with its continuous nature.
It is important to protect RKF, irrespective of their chosen modality of kidney replacement therapy. This includes the use of agents to block the renin-angiotensin-aldosterone system, avoidance of nonsteroidal inflammatory drugs and radiocontrast agents, volume depletion, and sodium phosphate bowel preparations. Prolonged use of aminoglycosides and other nephrotoxins should also be avoided. Short-term use of aminoglycosides in patients with ESKD is safe and can be used, pending identification and sensitivity of organisms causing peritonitis with subsequent change to an alternative nonaminoglycoside agent later.