Nephrol Dial Transplant (2006) 21: 1334–1339
doi:10.1093/ndt/gfi023
Advance Access publication 26 July 2005
Original Article
Effect of radio contrast media on residual renal function
in peritoneal dialysis patients—a prospective study
Elisabeth Dittrich1, Heidi Puttinger1, Martin Schillinger2, Irene Lang3, Thomas Stefenelli3,
Walter H. Hörl1 and Andreas Vychytil1
1
Department of Medicine III, Division of Nephrology and Dialysis, 2Department of Medicine II,
Division of Angiology and 3Department of Medicine II, Division of Cardiology, Medical University Vienna,
Währinger Gürtel 18–20, A-1090 Vienna, Austria
Abstract
Background. Residual renal function is an independent predictor of survival in peritoneal dialysis
patients. Systemic administration of radio contrast
media (CM) may increase the risk of acute renal failure
in patients with impaired renal function not on
dialysis. There are few data on the influence of CM
administration in dialysis patients.
Methods. We investigated residual renal function in
10 continuous ambulatory peritoneal dialysis (CAPD)
patients who underwent elective diagnostic intravenous or intra-arterial administration of CM (study
group). Iopromide (a iodinated, non-ionic hypoosmolar CM) was used for all interventions. The
median dose of CM given was 107.5 ml/patient.
Residual renal function (calculated as the average
of renal creatinine and renal urea clearance) was
measured on the day before the intervention (baseline),
on days 1–7, day 10 and day 30 after intervention.
Eight CAPD patients without exposure to CM acted as
the control group.
Results. There was no significant difference between
the two groups in age, gender, diabetes, duration of
dialysis and renal clearance at baseline. In the study
group, we observed a temporary decline of residual
renal clearance after administration of CM (P<0.05;
Friedman test). On day 30, clearances were not
significantly different from baseline. In the control
group, there was no significant change of residual
clearance during the observation period. Repeated
measures ANOVA revealed no significant difference in
the course of residual renal function between study and
control groups. The decline of residual renal clearance
between baseline and a routine visit after 4 months was
comparable between groups.
Correspondence and offprint requests to: Elisabeth Dittrich, MD,
Division of Nephrology and Dialysis, Department of Medicine III,
Medical University Vienna, Währinger Gürtel 18–20, A-1090
Vienna, Austria. Email: [email protected]
Conclusion. Administration of iopromide did not
lead to a persistent decline of residual renal function
in CAPD patients. Nevertheless, non-ionic hypoosmolar CM should be given to these patients with
the lowest possible dose and only if there is a real
clinical indication.
Keywords: angiography; iopromide; renal failure;
residual diuresis
Introduction
Several recent studies have shown that residual renal
clearance and peritoneal clearance of small solutes
are not equivalent [1–3]. In peritoneal dialysis (PD)
patients, there is a strong relationship between residual
renal function and oral calorie intake [4], risk of
infection [5], hospitalization [5], quality of life [6],
hypertension [7], as well as left ventricular hypertrophy
[8]. Furthermore, in contrast to peritoneal small solute
clearance, residual renal clearance is a strong independent predictor of survival [1–3]. Therefore, it is essential
to preserve residual renal function in dialysis patients
as long as possible. Among the suggested prophylactic
strategies are application of angiotensin-converting
enzyme (ACE) inhibitors or angiotensin II receptor
blockers, use of biocompatible dialysis solutions,
prevention of peritonitis and avoidance of nephrotoxic
drugs such as aminoglycosides, non-steroidal antiinflammatory agents and radio contrast media (CM)
[9,10]. Intravenous administration of CM may increase
the risk of acute renal failure in non-dialysis patients,
especially in those with impaired renal function [11,12].
Interestingly, several retrospective studies could not
show any long-term influence of intravenous application of CM on the decline of residual renal function
in PD patients or did not consider this aspect [13–16].
ß The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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Radio contrast media and residual renal function
In this prospective study, we investigated the effect of
administration of CM on renal clearance in stable PD
patients.
Patients and methods
Clinically stable continuous ambulatory peritoneal dialysis
(CAPD) patients with residual renal function (defined as
residual renal clearance >1.5 ml/min/1.73 m2) who underwent
elective diagnostic intra-arterial or intravenous administration of contrast agents were included consecutively in the
study group. Patients were older than 18 years and treated
with PD for at least 2 months before inclusion.
Iopromide (ULTRAVISTÕ , SCHERING-WIEN, Vienna,
Austria; a iodinated, non-ionic hypo-osmolar CM) was used
for all interventions. The decision on the amount of CM
administered in the individual patient was based on clinical
requirements. Exclusion criteria were congestive heart failure
(ejection fraction <35%), clinical signs of dehydration,
allergy against CM, hyperthyroidism, severe hepatic disease,
systemic infection within 1 week before the start of the
study, neoplasia without remission, poor patient compliance,
change in ACE inhibitor dose and start of non-steroidal antiinflammatory drug therapy or therapy with nephrotoxic
antibiotics within 1 week prior to screening.
The primary end-point was the change of residual renal
clearance within 1 month after contrast administration. To
calculate renal clearances, each patient was asked to collect
24 h urine samples on the day before CM administration
(baseline), as well as on days 1–7, day 10 and day 30 after the
intervention. Blood samples (once daily) were taken at the
same time points. No pre-medication (e.g. acetylcysteine
or theophylline) or intravenous hydration was given before
CM administration. However, patients were asked to maintain an oral fluid intake of 500 ml above the total of 24 h urine
volume and 24 h peritoneal ultrafiltration to avoid negative
fluid balance or dehydration.
In the control group, patients (older than 18 years and
clinically stable on CAPD for at least 2 months) without
exposure to CM during the last 8 months before the study
began were included consecutively in the order of the date of
their routine control. Diagnostic procedures were the same
in this group, including sampling of 24 h urine and blood on
eight consecutive days (corresponding to baseline and day
1–7), on day 10 and on day 30.
Additionally, values of residual renal clearance measured
in patients of both groups during a routine visit 4 months
after baseline were included in the final analysis.
Blood and dialysate chemistry as well as blood cell count
were performed using routine methods. Residual renal
clearance (in ml/min) was calculated as the average of renal
creatinine and renal urea clearance, using the PD adequest
2.0 programme (Baxter Healthcare Cooperation, Deerfield, IL)
and normalized to 1.73 m2 body surface area. At baseline, as
well as on days 1–7, 10 and 30, both patients in the study
group and those in the control group underwent a clinic
evaluation. During this visit, a physical examination, 24 h
fluid balance (to ensure that all patients were euvolaemic)
and blood pressure measurements were performed. The study
protocol was approved by the Ethics Committee of the
Medical University Vienna. Each patient gave written
informed consent before inclusion in the study.
1335
Statistics
Continuous data are presented as the median and the
interquartile range (IQR, range from the 25th to the 75th
percentile). Discrete data are given as counts and percentages.
We used Fisher’s exact tests to compare proportions,
and Mann–Whitney U-tests and Wilcoxon paired tests for
univariate comparison of continuous data, as appropriate.
Repetitive measurements within groups of continuous data
were analysed by Friedman tests. Furthermore, we performed
a repeated measures analysis of variance (ANOVA) defining
the time and patient/control group as crossed fixed effects
and the subjects nested in the group, and testing for interaction between group and time to assess a potential differential profile between study and control group. A two-sided
P-value <0.05 was considered statistically significant.
Calculations were performed with Stata (release 8.0) and
SPSS for Windows (Version 10.0, SPSS Inc., Chicago, IL).
Results
Patient flow
Twelve CAPD patients were included in the study
group. There were two adverse events in two patients.
These two patients dropped out because of hypertensive crisis without signs of hypervolaemia in one case
and a severe bleeding complication at the puncture
site complicated by secondary infection in the other.
Therefore, 10 patients remained in this group for final
statistical analysis. Eight CAPD patients were included
in the control group. All eight patients completed the
study. In none of the control patients have adverse
events been reported.
Baseline characteristics
Underlying kidney diseases were chronic glomerulonephritis (n ¼ 2 in the study group and n ¼ 4 in the control
group), diabetes (n ¼ 2 in the study group and n ¼ 2 in
the control group), polycystic kidney disease (n ¼ 2 in
the study group), chronic interstitial nephritis (n ¼ 2
in the study group), vascular nephropathy (n ¼ 1 in the
study group) and end-stage renal disease of unknown
origin (n ¼ 1 in the study group and n ¼ 2 in the control
group). Co-morbid conditions were equally balanced
in the two groups [Charlson co-morbidity index:
patient group 4.5 (median; IQR 3.0–7.5) vs control
group 4.0 (median; IQR 3.0–5.0), P ¼ 0.55]. Table 1
shows the patient characteristics. There was no significant difference in age, gender, duration of dialysis,
prevalence of diabetes and hypertension, proteinuria,
serum albumin, use of ACE inhibitors, angiotensin II
receptor blockers, calcium channel blockers or diuretics, baseline urine volume and baseline residual
clearance between the study group and the control
group. None of the patients received non-steroidal
anti-inflammatory drugs or nephrotoxic antibiotics
within the observation period. There was no change
in the PD protocol. Treatment volume was comparable
between both groups. Three patients in each group
1336
E. Dittrich et al.
Table 1. Demographic and clinical data of PD patients included in the study group and the control group
Gender (F/M)
Age (years)
Body mass index (kg/m2)
Diabetes mellitus n (%)
Hypertension n (%)
Duration of dialysis (months; median, IQR)
Baseline residual renal function (ml/min/1.73 m2; median, IQR)
Baseline urine volume (ml/day; median, IQR)
ACE inhibitor/angiotensin II receptor blockers n (%)
Calcium channel blockers n (%)
Diuretics n (%)
Serum albumin (g/l; median, IQR)
Proteinuria (g/day; median, IQR)
a
Study group (n ¼ 10)
Control group (n ¼ 8)
P-value
4/6
62.5
23.5
2
9
12.5
5.5
1850
4
5
6
36.6
0.31
3/5
47.5
27
2
8
15.5
6.6
1650
6
5
5
36.6
0.98
0.99a
0.36b
0.99b
0.99a
0.99a
0.36b
0.41b
0.90b
0.19a
0.66a
0.99a
0.97b
0.17b
(45.3–67.8)
(21.0–28.8)
(20%)
(90%)
(2.8–19.8)
(2.9–8.1)
(1050–2150)
(40%)
(50%)
(60%)
(34.2–39.3)
(0.14–1.18)
(45.3–63.3)
(25.3–33.0)
(25%)
(100%)
(11.3–26.0)
(6.0–8.7)
(1325–2025)
(75%)
(63%)
(63%)
(34.1–39.1)
(0.25–1.71)
Fisher’s exact test.
Mann–Whitney U-test.
b
Reason for exposure to
contrast medium
1
2
Coronary angiography
Coronary angiography
3
4
5
6
7
8
9
Coronary angiography
Coronary angiography
Computed tomography
of the kidneys
Peripheral angiography þ PTA
Coronary angiography þ PCI
Coronary angiography þ PCI
Coronary angiography
10
Coronary angiography
Dose of iopromide
(concentration of iodine)
60 ml
110 ml
45 ml
80 ml
60 ml
120 ml
(370 mg/ml)
(370 mg/ml) þ
(300 mg/ml)
(370 mg/ml)
(370 mg/ml)
(300 mg/ml)
190 ml
430 ml
150 ml
50 ml
45 ml
60 ml
(300 mg/ml)
(370 mg/ml)
(370 mg/ml)
(370 mg/ml) þ
(300 mg/ml)
(370 mg/ml)
PCI ¼ percutaneous coronary intervention; PTA ¼ percutaneous
transluminal angioplasty.
performed one dialysate exchange per day with
icodextrin.
Table 2 displays the amount of CM applied and
the type of intervention performed in the patients of
the study group. Five patients received <100 ml of
iopromide, four patients received 100–200 ml and only
one patient received >200 ml.
14.0
Residual renal clearance
(ml/min/1.73m2)
Patient
Individual course of residual renal clearance
(study group)
12.0
10.0
8.0
6.0
4.0
2.0
0.0
baseline 1
2
3
4
5
6
7
10
30
Time interval (days)
Individual course of residual renal clearance
(control group)
14.0
Residual renal clearance
(ml/min/1.73m2)
Table 2. Reasons for exposure to iopromide, amount of contrast
medium applied and concentration of iodine (in mg/ml) in PD
patients
12.0
10.0
8.0
6.0
4.0
2.0
0.0
baseline 1
2
3
4
5
6
7
10
30
Time interval (days)
Fig. 1. Serial data of residual renal clearance (in ml/min/1.73 m2) of
each patient of the study group and of the control group.
Residual renal clearance
Figure 1 displays serial data of the residual renal
clearance of each patient. The course of residual
renal clearance for the two patient groups is shown
in Table 3 (absolute values) and Figure 2 (differences
from baseline). In the study group, there was a
temporary decline of residual renal clearance after
administration of iopromide. The lowest median
level of renal clearances was reached on day 6
[3.78 ml/min/1.73 m2 (IQR 2.56–6.77 vs baseline
5.50 ml/min/1.73 m2 (IQR 2.91–8.10)] (Table 3).
Thereafter, renal clearances increased again. On
day 30, there was no significant difference in clearances
as compared with baseline values. Using the Friedman
test, there was a significant difference in the course
of renal clearances in the study group (P ¼ 0.049,
Figure 2). In the control group, there was no significant change of residual renal clearance between baseline and day 30.
Radio contrast media and residual renal function
1337
Table 3. Peritoneal ultrafiltration, residual renal clearance (RRC) and urine volume in PD patients included in the study group (n ¼ 10)
and the control group (n ¼ 8), presented as median and IQR (25th–75th percentile)
Baseline
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 10
Day 30
Ultrafiltration (ml/24 h)
RRC (ml/min/1.73 m2)
Urine volume (ml/24 h)
Study group
Control group
Study group
Control group
Study group
Control group
210
425
700
790
715
775
645
540
600
425
865
895
925
965
845
870
935
770
850
960
5.50
5.50
4.48
5.03
4.72
4.45
3.78
4.50
4.64
4.76
6.64
5.67
5.52
5.99
5.73
5.58
5.71
6.52
7.11
5.16
1850
2025
1100
1375
1425
1250
1450
1150
1350
1500
1650
1520
1400
1460
1550
1550
1650
1775
1450
1350
(163–808)
(98–710)
(543–1215)
(325–1260)
(318–1270)
(543–1285)
(250–1305)
(303–1250)
(150–785)
(85–904)
Residual renal clearance
Difference from baseline (ml/min/1.73m2)
5
(655–1040)
(783–1045)
(730–1095)
(715–1120)
(743–1085)
(775–1110)
(865–1175)
(695–1275)
(785–1120)
(890–1310)
(2.91–8.10)
(3.38–7.62)
(2.49–7.35)
(3.12–6.47)
(1.88–6.92)
(2.25–6.64)
(2.56–6.77)
(2.88–5.90)
(2.77–7.96)
(2.89–5.81)
study group
control group
p=0.049
p=0.82
(6.01–8.71)
(5.01–9.46)
(4.65–9.26)
(4.93–8.76)
(4.10–9.63)
(4.84–8.34)
(4.77–8.53)
(5.15–7.87)
(4.97–8.64)
(4.62–8.80)
(1050–2150)
(1513–2238)
(713–1750)
(850–1700)
(1100–1805)
(1075–1825)
(963–1638)
(963–1800)
(1213–1813)
(1175–2238)
(1325–2025)
(1125–1888)
(1013–1850)
(1100–1950)
(1188–1900)
(1200–1838)
(1175–2125)
(1475–2063)
(1250–2038)
(825–1975)
4
3
2
1
0
−1
−2
−3
−4
−5
1
2
3
4
5
6
7 10 30
1
2
3
4
5
6
7 10 30
Time interval (days)
Fig. 2. Residual renal clearance in PD patients (shown as difference from baseline in ml/min/1.73 m2) included in the study group (n ¼ 10)
and the control group (n ¼ 8). The box plots indicate median, interquartile range and range. P was determined by the Friedman test.
As an alternative to this non-parametric statistical
approach, we used repeated measures ANOVA to
assess a difference in the course of residual renal
function in study and control group. However, we
observed no significant difference in the course of
residual renal function between patients and controls
as indicated by the absence of a significant interaction between case/control and time interval (P ¼ 0.23).
Nevertheless, inspection of the residuals showed
a non-normal distribution, which could not be
transformed to normal by logarithmic or squared
transformation.
Residual renal clearance 4 months after baseline
was 4.48 ml/min/1.73 m2 (median; IQR 2.63–6.36) in
patients of the study group and 4.89 ml/min/1.73 m2
(median; IQR 3.98–7.69) in control patients (P ¼ 0.48).
There was no significant difference in the decline
of residual renal function from baseline to 4 months
between the two groups (P ¼ 0.89).
Blood pressure control, peritoneal
ultrafiltration and body weight
None of the patients who completed the study had
any change of blood pressure, number or dose of
antihypertensive agents or signs of overhydration.
Peritoneal ultrafiltration and urine volumes in both
patient groups are shown in Table 3. In patients after
CM administration, peritoneal fluid removal increased
within the observation period. However, ultrafiltration
tended to be larger in the control group as compared
with the study group. The average ultrafiltration (day 1
to day 30) was 480 ml (median; IQR 394–1192) in the
study group and 877 ml (median; IQR 705–1199) in
the control group. This difference did not reach the
level of significance (P ¼ 0.122, Mann–Whitney U-test).
The average urine volume was 1382 ml (median; IQR
1010–2094) in the study group and 1565 ml (median;
IQR 1151–2092) in the control group (P ¼ 0.965,
1338
Mann–Whitney U-test). There was no major change
in body weight during the observation period (data
not shown).
Discussion
Intravenous administration of CM is associated with
acute renal failure in patients with impaired renal
function [11,12]. The influence of intravenous CM on
decline of residual renal function in dialysis patients is
less well documented. Several studies have identified
factors impairing residual renal clearance in dialysis
patients, such as enhanced peritoneal ultrafiltration,
increased dialysate treatment volumes, dehydration,
large body mass index, untreated hypertension, high
peritonitis rate, presence of cardiomyopathy, diabetes,
marked proteinuria and use of aminoglycosides
[13–18]. Some of these studies, however, did not
consider the effect of intravenous administration of
CM on renal clearances in their analyses [13,15,16,18].
In other retrospective analyses, administration of CM
had no long-term influence on residual renal function
in dialysis patients [14].
This is the first prospective study investigating
the influence of CM on residual renal function in PD
patients. We found a mild decline of renal clearance
after administration of iopromide (a iodinated, nonionic hypo-osmolar CM) as compared with a control
group. This effect, however, was temporary, with a
minimum median level of renal clearances on day 6.
Our results differ from those published in non-dialysed
subjects, in whom the maximal increase of creatinine
in the case of CM-associated nephropathy usually
occurs within 72 h after injection [19,20]. The change
of renal clearance was significant using the Friedman
test, but we did not find a significant interaction
between case/control and time interval in the repeated
measures ANOVA. These differences might be
explained by the non-normal distribution of the data
set (normal distribution is ideally required for performing ANOVA, but not necessarily for analysis using
Friedman test). However, a type II error cannot be
excluded. Nevertheless, visual inspection of the data
(Figure 2) suggests a moderate and temporary decline
of renal clearances in the study group.
There may be several reasons for the lack of a
persistent effect of CM administration in PD patients.
Apart from renal haemodynamic changes, direct
tubular toxicity also plays a role in the occurrence of
CM-associated nephropathy [19]. In dialysis patients,
however, renal clearance of CM is reduced, and toxic
levels in the renal tubular system may occur later and
may be lower than in subjects with normal renal function. Secondly, the incidence of acute renal impairment
depends on the amount of CM applied [12]. The dose
of CM used in most of our patients was rather low.
Only two patients received >160 ml of iopromide.
In the study group, peritoneal fluid removal
increased during the observation period. However,
peritoneal ultrafiltration at baseline as well as average
E. Dittrich et al.
peritoneal ultrafiltration over the study period
remained lower in the study group as compared with
the control group. This difference did not reach the
level of significance. Since patients did not change their
PD regimen and continued to use the same glucose
concentration as before the start of the study, the
observed increase in ultrafiltration in the study group
is probably explained by random variation. Increased
peritoneal fluid removal is correlated with a more
rapid decline of residual renal clearance. From this
point of view, a decrease of residual renal clearance
would be expected in the control group rather than
in the study group. Considering this aspect as well
as the fact that all patients were euvolaemic, the
observed differences in ultrafiltration between groups
most probably do not explain a decline in residual
renal function after CM administration.
There are some limitations to this study. Based
on the presented data, we cannot draw conclusions
about possible long-term effects (beyond 4 months) of
intravenous injection of iopromide. The fact, however,
that there was no significant difference between
clearance values after 30 days and those at baseline
makes such a long-term effect on residual renal
function unlikely. Furthermore, the decline of residual
renal clearance from baseline to 4 months was
comparable between patients of the study group and
those of the control group. The only marginal change
of residual renal clearance observed in study patients
in the present study may also explain why retrospective
studies could not find any long-term effect of CM on
residual renal function. Of course, it cannot be excluded
that higher CM doses or repetitive short-term damage
due to several CM applications (as necessary in some
dialysis patients) may lead to a persisting decrease of
renal clearance.
The patient number in this study was rather small,
because only those with elective CM application and
good patient compliance (24 h urine sampling over
several days) were included. We are aware of the
shortcomings of an unadjusted analysis comparing
such small sample sizes. Finding no significant differences in baseline characteristics between the groups
certainly does not mean that these differences do
not exist or are clinically irrelevant, e.g. imbalances
between the use of ACE inhibitors or differences in
average proteinuria, hypertension and amount of
co-morbidity. Nevertheless, the small sample sizes do
not allow us to perform adjusted multivariate analyses,
and our results therefore have to be interpreted with
some caution. However, the only temporary decline of
residual renal clearance in the study group suggests
an effect of CM and cannot be solely explained by
differences in the above-mentioned baseline factors,
which remained unchanged throughout the observation
period.
It was part of the study protocol that the same CM
was used for all interventions. For ethical reasons,
however, the decision on the amount of CM given
had to be based on clinical requirements and was left
to the physician who performed the investigation.
Radio contrast media and residual renal function
Therefore, the dose of iopromide differed between
individual patients of the study group. Because of the
small sample size, we did not correlate the dose of
CM with the decrease in residual renal clearance.
Finally, further studies are needed to clarify if the effect
of iopromide on residual renal function found in our
study is also transferable to other CM.
In summary, administration of iopromide did not
have a persistent effect on residual renal function
in CAPD patients. However, the temporary decline
observed during the first week after exposure to CM
should be noted. The tremendous influence of residual
renal clearance on the outcome of PD patients is
undisputed. Our results suggest that physicians
should not refrain from intravascular injection of
non-ionic hypo-osmolar CM in these patients, if
there is a real clinical indication. However, doses of
CM must be chosen to be as low as possible, and
precautionary measures (e.g. adequate hydration)
should be considered.
1339
7.
8.
9.
10.
11.
12.
Conflict of interest statement. None declared.
13.
References
14.
1. Rocco M, Soucie JM, Pastan S, McClellan WM. Peritoneal
dialysis adequacy and risk of death. Kidney Int 2000; 58: 446–457
2. Bargman JM, Thorpe KE, Churchill DN. Relative contribution
of residual renal function and peritoneal clearance to adequacy
of dialysis: a reanalysis of the CANUSA study. J Am Soc
Nephrol 2001; 12: 2158–1262
3. Paniagua R, Amato D, Vonesh E et al. Effects of increased
peritoneal clearances on mortality rates in peritoneal dialysis:
ADEMEX, a prospective, randomized, controlled trial. J Am
Soc Nephrol 2002; 13: 1307–1320
4. Wang AYM, Sea MMM, Ip R et al. Independent effects of
residual renal function and dialysis adequacy on actual dietary
protein, calorie, and other nutrient intake in patients on
continuous ambulatory peritoneal dialysis. J Am Soc Nephrol
2001; 12: 2450–2457
5. Szeto CC, Lai KN, Wong TYH et al. Independent effects
of residual renal function and dialysis adequacy on nutritional
status and patient outcome in continuous ambulatory peritoneal
dialysis. Am J Kidney Dis 1999; 34: 1056–1064
6. Termorshuizen F, Korevaar JC, Dekker FW, van Manen JG,
Boeschoten EW, Krediet RT. The relative importance of
residual renal function compared with peritoneal clearance for
15.
16.
17.
18.
19.
20.
patient survival and quality of life: an analysis of the
Netherlands Cooperative Study on the Adequacy of Dialysis
(NECOSAD)-2. Am J Kidney Dis 2003; 41: 1293–1302
Menon MK, Naimark DM, Bargman JM, Vas SI,
Oreopoulos DG. Long-term blood pressure control in a
cohort of peritoneal dialysis patients and its association with
residual renal function. Nephrol Dial Transplant 2001; 16:
2207–2213
Wang AYM, Wang M, Woo J et al. A novel association
between residual renal function and left ventricular hypertrophy in peritoneal dialysis patients. Kidney Int 2002; 62:
639–647
Lameire NH. The impact of residual renal function on the
adequacy of peritoneal dialysis. Nephron 1997; 77: 13–28
Suzuki H, Kanno Y, Sugahara S, Okada H, Nakamoto H.
Effects of an angiotensin II receptor blocker, valsartan, on
residual renal function in patients on CAPD. Am J Kidney Dis
2004; 43: 1056–1064
Rudnick MR, Goldfarb S, Wexler L et al. Nephrotoxicity
of ionic and nonionic contrast media in 1196 patients:
a randomized trial. The Iohexol Cooperative Study. Kidney
Int 1995; 47: 254–261
McCullough PA, Wolyn R, Rocher LL, Levin RN,
O’Neill WW. Acute renal failure after coronary intervention:
incidence, risk factors and relationship to mortality. Am J Med
1997; 103: 368–375
Shin SK, Noh H, Kang SW et al. Risk factors influencing the
decline of residual renal function in continous ambulatory
peritoneal dialysis patients. Perit Dial Int 1999; 19: 138–142
Singhal MK, Bhaskaran S, Vidgen E, Bargman JM, Vas SI,
Oreopoulos DG. Rate of decline of residual renal function
in patients on continuous peritoneal dialysis and factors
affecting it. Perit Dial Int 2000; 20: 429–438
Jansen MAM, Hart AAM, Korevaar JC, Dekker FW,
Boeschoten EW, Krediet RT. Predictors of the rate of decline
of residual renal function in incident dialysis patients. Kidney
Int 2002; 62: 1046–1053
Johnson DW, Mudge DW, Sturtevant JM et al. Predictors of
decline of residual renal function in new peritoneal dialysis
patients. Perit Dial Int 2003; 23: 276–283
Shemin D, Maaz D, St Pierre D, Kahn SI, Chazan JA. Effect
of aminoglycoside use on residual renal function in peritoneal
dialysis patients. Am J Kidney Dis 1999; 34: 14–20
Moist LM, Port FK, Orzol SM et al. Predictors of loss of
residual renal function among new dialysis patients. J Am Soc
Nephrol 2000; 11: 556–564
Porter GA. Contrast-associated nephropathy: presentation,
pathophysiology and management. Miner Electrolyte Metab
1994; 20: 232–243
Aspelin P, Aubry P, Fransson SG et al. Nephrotoxic effects in
high-risk patients undergoing angiography. N Engl J Med 2003;
348: 491–499
Received for publication: 9.9.04
Accepted in revised form: 22.6.05