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Stabilization of glomerular filtration rate in advanced chronic kidney disease: a two-year follow-up of a cohort of chronic kidney disease patients stages 4 and 5.
Adv Chronic Kidney Dis. 2007 Jan; 14(1):105-12.AC

Abstract

This study examines whether stabilization of the glomerular filtration rate (GFR) is possible in patients with advanced chronic kidney disease (CKD), managed in a CKD clinic. A cohort of 82 patients with stages 4 and 5 CKD was followed for a period of 2 years after initiation of erythropoietin for anemia to determine the GFR and the frequency of primary outcomes (dialysis, transplantation, or death). GFR, calculated by the abbreviated Modification of Diet in Renal Disease formula, was determined every 3 months. After 24 months, 35 subjects (43%) developed a primary outcome. Controlled for other risk factors, the risk of having a primary outcome increased 19.7% for every unit that the GFR decreased (95% confidence interval [CI], 11.9%-26.8%, P < .001) and decreased 21.7% for every unit that the hemoglobin increased (95% CI, 0.5%-38.4%, P < .001). Blacks had a 3.1 times higher risk (95% CI, 1.4-6.9, P = .006) of developing a primary outcome than other ethnicities. In subjects who did not develop primary outcomes (n = 47 or 57%), GFR remained unchanged (19.5 +/- 9.1 at the end of the study v 20.8 +/- 5.3 mL/min/1.73 m(2) at baseline, P = .16). The standardized mortality rate was 4.75 and 9.77 per 100 person-year for stages 4 and 5, respectively. We conclude that stabilization of GFR over a 2-year period can be achieved in many patients with advanced CKD treated with erythropoietin in a CKD clinic. Although the precise reason for the stabilization of GFR cannot be elucidated from this study, our data are "proof of concept" that CKD outcomes can be improved in a CKD clinic setting.

Authors+Show Affiliations

Division of Nephrology/Hypertension, Northwestern University, The Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL 60611, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17200050

Citation

Serrano, Andres, et al. "Stabilization of Glomerular Filtration Rate in Advanced Chronic Kidney Disease: a Two-year Follow-up of a Cohort of Chronic Kidney Disease Patients Stages 4 and 5." Advances in Chronic Kidney Disease, vol. 14, no. 1, 2007, pp. 105-12.
Serrano A, Huang J, Ghossein C, et al. Stabilization of glomerular filtration rate in advanced chronic kidney disease: a two-year follow-up of a cohort of chronic kidney disease patients stages 4 and 5. Adv Chronic Kidney Dis. 2007;14(1):105-12.
Serrano, A., Huang, J., Ghossein, C., Nishi, L., Gangavathi, A., Madhan, V., Ramadugu, P., Ahya, S. N., Paparello, J., Khosla, N., Schlueter, W., & Batlle, D. (2007). Stabilization of glomerular filtration rate in advanced chronic kidney disease: a two-year follow-up of a cohort of chronic kidney disease patients stages 4 and 5. Advances in Chronic Kidney Disease, 14(1), 105-12.
Serrano A, et al. Stabilization of Glomerular Filtration Rate in Advanced Chronic Kidney Disease: a Two-year Follow-up of a Cohort of Chronic Kidney Disease Patients Stages 4 and 5. Adv Chronic Kidney Dis. 2007;14(1):105-12. PubMed PMID: 17200050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stabilization of glomerular filtration rate in advanced chronic kidney disease: a two-year follow-up of a cohort of chronic kidney disease patients stages 4 and 5. AU - Serrano,Andres, AU - Huang,Jie, AU - Ghossein,Cybele, AU - Nishi,Laura, AU - Gangavathi,Anupama, AU - Madhan,Vijayachitra, AU - Ramadugu,Paramesh, AU - Ahya,Shubhada N, AU - Paparello,James, AU - Khosla,Neenoo, AU - Schlueter,William, AU - Batlle,Daniel, PY - 2007/1/4/pubmed PY - 2007/4/4/medline PY - 2007/1/4/entrez SP - 105 EP - 12 JF - Advances in chronic kidney disease JO - Adv Chronic Kidney Dis VL - 14 IS - 1 N2 - This study examines whether stabilization of the glomerular filtration rate (GFR) is possible in patients with advanced chronic kidney disease (CKD), managed in a CKD clinic. A cohort of 82 patients with stages 4 and 5 CKD was followed for a period of 2 years after initiation of erythropoietin for anemia to determine the GFR and the frequency of primary outcomes (dialysis, transplantation, or death). GFR, calculated by the abbreviated Modification of Diet in Renal Disease formula, was determined every 3 months. After 24 months, 35 subjects (43%) developed a primary outcome. Controlled for other risk factors, the risk of having a primary outcome increased 19.7% for every unit that the GFR decreased (95% confidence interval [CI], 11.9%-26.8%, P < .001) and decreased 21.7% for every unit that the hemoglobin increased (95% CI, 0.5%-38.4%, P < .001). Blacks had a 3.1 times higher risk (95% CI, 1.4-6.9, P = .006) of developing a primary outcome than other ethnicities. In subjects who did not develop primary outcomes (n = 47 or 57%), GFR remained unchanged (19.5 +/- 9.1 at the end of the study v 20.8 +/- 5.3 mL/min/1.73 m(2) at baseline, P = .16). The standardized mortality rate was 4.75 and 9.77 per 100 person-year for stages 4 and 5, respectively. We conclude that stabilization of GFR over a 2-year period can be achieved in many patients with advanced CKD treated with erythropoietin in a CKD clinic. Although the precise reason for the stabilization of GFR cannot be elucidated from this study, our data are "proof of concept" that CKD outcomes can be improved in a CKD clinic setting. SN - 1548-5595 UR - https://www.unboundmedicine.com/medline/citation/17200050/Stabilization_of_glomerular_filtration_rate_in_advanced_chronic_kidney_disease:_a_two_year_follow_up_of_a_cohort_of_chronic_kidney_disease_patients_stages_4_and_5_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1548-5595(06)00114-5 DB - PRIME DP - Unbound Medicine ER -