Factors affecting loss of residual renal function(s) in dialysis

Many physiological processes relate to two aspects of kidney function: (1) excretory and secretory (excretion of electrolytes and water, elimination of metabolic end products and uremic toxins, regulation of the acid- base status), and (2) endocrine functions (regulating bone and mineral metabolism and red blood cell production). Decreases in renal functions are known to be associated with shortened survival. The exact mechanisms for this are still to be elucidated but evidence in the literature suggests mechanisms such as adverse effects of accumulation of uremic toxins, fluid overload, inflammation and possibly loss of antioxidant functions. Knowledge of factors affecting decrease of residual renal function is currently based on observational data only. Possible strategies to preserve residual renal function have been suggested but require confirmation in adequately powered prospective trials to test their effectiveness.