Examining the Validity of a Subjective Urine Questionnaire for Residual Kidney Function Among Recruited Participants of the Incremental Hemodialysis in Veterans (INCHVETS) Randomized Controlled Trial

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Background: Higher residual renal function (RRF) in incident hemodialysis (HD) patients can support uremia management, so that less than thrice-weekly HD can be instituted. We hypothesized that urine volume (UV), a surrogate of RRF at the onset of HD transition, can be estimated using questionnaires. Methods: We developed and tested the accuracy of a subjective UV in recruited human subjects of the INCHVETS trial, with several incremental responses to the question: “How much urine do you usually make a day?” 1) no more than 1 coffee mug. 2) 1 to 2 coffee mugs, 3) More than 2 coffee mugs but no more than 1 quart, and 5) more than a quart a day. We also asked: “Do you wake up at night to go to bathroom to pee?” with the answer options of Yes versus No/Not sure. We collected and measured 24 hour-output at baseline prior to randomization to twice vs thrice weekly HD in the first 8 weeks of dialysis initiation. Results: In the first 109 recruited patients of the INCHVETS trial, the mean age is 70 (SD: ±9) years. They include 94% male, 51% Black Americans, and 23% Hispanics; and 67% has diabetes mellitus at dialysis initiation. Measured UV (mUV) was incrementally higher across 5 subjectively reported (p-for-trend <0.05, see Table 1), but reported nocturia was not significantly different: Yes (87%): 1,227±532 ml/day, No/not sure (13%) 1,105±592 ml/day. Conclusion: In the first 109 INCHVETS trial patients, patients’ subjective estimates of their urine shows a positive trend with measured 24-hour urine output, while reported nocturia exhibited no association with reported or measured urine output. Given the requirement of at least 500 ml/day of urine to participate in the INCHVETS trial, we will compare the change in RRF over the 12 months of trials in patients who are randomized to twice- vs thrice-weekly HD. Funding: Veterans Affairs Support

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