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Predicting mortality and uptake of renal replacement therapy in patients with stage 4 chronic kidney disease.
Nephrol Dial Transplant. 2009 Jun; 24(6):1930-7.ND

Abstract

BACKGROUND

Novel strategies are required to efficiently manage the increasing number of patients diagnosed with chronic kidney disease (CKD). We sought to identify factors predicting outcome in patients with stage 4 CKD and to determine whether low-risk patients could be managed in primary care.

METHODS

We performed a two-centre, retrospective cohort study including 396 patients with stage 4 CKD referred to nephrology clinics from 1998 to 2002. We utilized electronic databases to determine the incidence of renal replacement therapy (RRT) and mortality and the rate of deterioration in estimated glomerular filtration rate (eGFR) to the year end 2005.

RESULTS

This was an elderly cohort, with 71.7% of patients aged > or =65 years. The risk of surviving to require dialysis fell with increasing age (HR 0.44; 95% CI: 0.23-0.84 for those >74 years verses those <65 years), in part due to the slower rate of decline in renal function in older patients (median fall in eGFR was -2.25, -1.38 and -0.86 ml/ min/1.73 m(2)/year in those aged <65 years, 65-74 years and >74 years, respectively, P < 0.0001). Additional independent risk factors predicting RRT included: high baseline proteinuria (HR 6.26; 95% CI: 2.74-14.23 for >3 g/24 h versus <0.3 g/24 h), greater early decline in renal function (HR 3.86; 95% CI: 2.34-6.38 for > or =4 ml/min/1.73 m(2)/year versus <4 ml/min/1.73 m(2)/year), low baseline eGFR (HR 2.92; 95% CI: 1.61-5.30 for 15-19 versus 25-29 ml/min/1.73 m(2)) and low haemoglobin (HR 3.16; 95% CI: 1.64-6.08 for <10 versus >12 g/dl). The 98 (24.7%) patients discharged to primary care had more stable renal function than those remaining under nephrology care (median change in eGFR of +0.20 versus -1.88 ml/ min/1.73 m(2)/year, P = 0.0001).

CONCLUSIONS

Most patients with stage 4 CKD, in particular the elderly, die without commencing RRT. Patients at low risk of progression can be identified and discharged safely to primary care with an active management plan.

Authors+Show Affiliations

Department of Renal Medicine, Royal Infirmary Edinburgh, Edinburgh, UK. bryan.conway@ed.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

19181760

Citation

Conway, Bryan, et al. "Predicting Mortality and Uptake of Renal Replacement Therapy in Patients With Stage 4 Chronic Kidney Disease." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 24, no. 6, 2009, pp. 1930-7.
Conway B, Webster A, Ramsay G, et al. Predicting mortality and uptake of renal replacement therapy in patients with stage 4 chronic kidney disease. Nephrol Dial Transplant. 2009;24(6):1930-7.
Conway, B., Webster, A., Ramsay, G., Morgan, N., Neary, J., Whitworth, C., & Harty, J. (2009). Predicting mortality and uptake of renal replacement therapy in patients with stage 4 chronic kidney disease. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 24(6), 1930-7. https://doi.org/10.1093/ndt/gfn772
Conway B, et al. Predicting Mortality and Uptake of Renal Replacement Therapy in Patients With Stage 4 Chronic Kidney Disease. Nephrol Dial Transplant. 2009;24(6):1930-7. PubMed PMID: 19181760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting mortality and uptake of renal replacement therapy in patients with stage 4 chronic kidney disease. AU - Conway,Bryan, AU - Webster,Angela, AU - Ramsay,George, AU - Morgan,Neal, AU - Neary,John, AU - Whitworth,Caroline, AU - Harty,John, Y1 - 2009/01/30/ PY - 2009/2/3/entrez PY - 2009/2/3/pubmed PY - 2009/8/26/medline SP - 1930 EP - 7 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 24 IS - 6 N2 - BACKGROUND: Novel strategies are required to efficiently manage the increasing number of patients diagnosed with chronic kidney disease (CKD). We sought to identify factors predicting outcome in patients with stage 4 CKD and to determine whether low-risk patients could be managed in primary care. METHODS: We performed a two-centre, retrospective cohort study including 396 patients with stage 4 CKD referred to nephrology clinics from 1998 to 2002. We utilized electronic databases to determine the incidence of renal replacement therapy (RRT) and mortality and the rate of deterioration in estimated glomerular filtration rate (eGFR) to the year end 2005. RESULTS: This was an elderly cohort, with 71.7% of patients aged > or =65 years. The risk of surviving to require dialysis fell with increasing age (HR 0.44; 95% CI: 0.23-0.84 for those >74 years verses those <65 years), in part due to the slower rate of decline in renal function in older patients (median fall in eGFR was -2.25, -1.38 and -0.86 ml/ min/1.73 m(2)/year in those aged <65 years, 65-74 years and >74 years, respectively, P < 0.0001). Additional independent risk factors predicting RRT included: high baseline proteinuria (HR 6.26; 95% CI: 2.74-14.23 for >3 g/24 h versus <0.3 g/24 h), greater early decline in renal function (HR 3.86; 95% CI: 2.34-6.38 for > or =4 ml/min/1.73 m(2)/year versus <4 ml/min/1.73 m(2)/year), low baseline eGFR (HR 2.92; 95% CI: 1.61-5.30 for 15-19 versus 25-29 ml/min/1.73 m(2)) and low haemoglobin (HR 3.16; 95% CI: 1.64-6.08 for <10 versus >12 g/dl). The 98 (24.7%) patients discharged to primary care had more stable renal function than those remaining under nephrology care (median change in eGFR of +0.20 versus -1.88 ml/ min/1.73 m(2)/year, P = 0.0001). CONCLUSIONS: Most patients with stage 4 CKD, in particular the elderly, die without commencing RRT. Patients at low risk of progression can be identified and discharged safely to primary care with an active management plan. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/19181760/Predicting_mortality_and_uptake_of_renal_replacement_therapy_in_patients_with_stage_4_chronic_kidney_disease_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfn772 DB - PRIME DP - Unbound Medicine ER -