Emerging importance of residual renal function in end-stage renal failure

Residual renal function (RRF) is well recognized as an important marker of outcomes in peritoneal dialysis (PD), and contributes vitally to solute clearance. Recently, its importance in hemodialysis (HD) has emerged with evidence that it is strongly associated with improved outcomes. The presence of RRF is associated with improved nutrition, reduced erythropoetin requirements, better potassium clearance, and improved quality of life. Retrospective and observational evidence is now available, which suggests that the presence of RRF is independently associated with survival and that this benefit goes beyond what is expected simply from augmentation of small solute clearance. Preservation of RRF is now considered by many to be an important aspect of dialysis strategy. Evidence in favor of one modality over another for preservation of RRF is conflicting, as are the potential benefits of biocompatible fluids in PD. In HD, the evidence in favor of biocompatible membranes is stronger. Emerging evidence is broadly in favor of angiotensin converting enzyme inhibitors for preservation of RRF. Diuretics appear to have a neutral effect. The complexities and practical difficulties in measurement of RRF have resulted in this important parameter being largely ignored in HD. Novel markers of renal function may provide alternative, simple methods of estimating RRF, which may remove the need for urine collections and simplify its measurement.