Preserving Residual Kidney Function in Haemodialysis: Current Practices, Challenges, and Perspectives From Renal Clinicians

BACKGROUND: Residual kidney function in patients receiving haemodialysis is associated with improved survival, reduced cardiovascular risk and better quality of life. Yet, clinical guidelines on its preservation are limited, and local practices remain unclear. OBJECTIVES: To explore current practices, perceptions and challenges related to residual kidney function preservation among renal clinicians. DESIGN: Descriptive cross-sectional survey. PARTICIPANTS: Renal physicians and nurses working in hospital-based haemodialysis units across Western Australia. MEASUREMENTS: Role-specific questionnaires were administered to renal physicians and nurses. RESULTS: Eighty-four completed responses were received (physicians n = 25; nurses n = 59). Over half of physicians (56%, n = 14) reported residual kidney function was present in more than half of patients at haemodialysis initiation, while most nurses (64%, n = 30) indicated it was often or always present. Assessment of this function was reported by 64% of physicians (n = 16) and 61% of nurses (n = 36), predominantly via patient self-reported urine output (physician 100%, n = 16; nurses 86%, n = 31). Most physicians (76%, n = 19) and nearly all nurses (90%, n = 53) believed preservation could improve patient outcomes. Key reported challenges included lack of consensus on optimal approaches (physicians 74%, n = 17; nurses 54%, n = 29), absence of clinical guidelines (nurses 61%, n = 33), difficulty in accurate assessment (physicians 65%, n = 15; nurses 52%, n = 28), and limited patient awareness (physician 57%, n = 13). Nurses identified staff education (83% n = 49) and practice guidelines (81%, n = 48) as key enablers to enhancing preservation efforts. CONCLUSIONS: While the clinical value of residual kidney function is widely recognised, its preservation in haemodialysis remains constrained by the lack of clinical consensus and guidelines, and limited awareness among patients and clinicians. Clear guidelines and targeted education are essential to integrate preservation practices into routine haemodialysis care.