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Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis.
Am J Kidney Dis. 2012 Apr; 59(4):513-22.AJ

Abstract

BACKGROUND

Little is known about patterns of kidney function decline leading up to the initiation of long-term dialysis.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

5,606 Veterans Affairs patients who initiated long-term dialysis in 2001-2003.

PREDICTOR

Trajectory of estimated glomerular filtration rate (eGFR) during the 2-year period before initiation of long-term dialysis.

OUTCOMES & MEASUREMENTS

Patient characteristics and care practices before and at the time of dialysis initiation and survival after initiation.

RESULTS

We identified 4 distinct trajectories of eGFR during the 2-year period before dialysis initiation: 62.8% of patients had persistently low level of eGFR < 30 mL/min/1.73 m2 (mean eGFR slope, 7.7 ± 4.7 [SD] mL/min/1.73 m2 per year), 24.6% had progressive loss of eGFR from levels of approximately 30-59 ml/min/1.73 m2 (mean eGFR slope, 16.3 ± 7.6 mL/min/1.73 m2 per year), 9.5% had accelerated loss of eGFR from levels > 60 mL/min/1.73 m2 (mean eGFR slope, 32.3 ± 13.4 mL/min/1.73 m2 per year), and 3.1% experienced catastrophic loss of eGFR from levels > 60 mL/min/1.73 m2 within 6 months or less. Patients with steeper eGFR trajectories were more likely to have been hospitalized and have an inpatient diagnosis of acute kidney injury. They were less likely to have received recommended predialysis care and had a higher risk of death in the first year after dialysis initiation.

CONCLUSIONS

There is substantial heterogeneity in patterns of kidney function loss leading up to the initiation of long-term dialysis perhaps calling for a more flexible approach toward preparing for end-stage renal disease.

Authors+Show Affiliations

Department of Medicine, VA Puget Sound Healthcare System and University of Washington, Seattle, WA 98108, USA. ann.ohare@va.govNo 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
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22305760

Citation

O'Hare, Ann M., et al. "Trajectories of Kidney Function Decline in the 2 Years Before Initiation of Long-term Dialysis." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 59, no. 4, 2012, pp. 513-22.
O'Hare AM, Batten A, Burrows NR, et al. Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. Am J Kidney Dis. 2012;59(4):513-22.
O'Hare, A. M., Batten, A., Burrows, N. R., Pavkov, M. E., Taylor, L., Gupta, I., Todd-Stenberg, J., Maynard, C., Rodriguez, R. A., Murtagh, F. E., Larson, E. B., & Williams, D. E. (2012). Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 59(4), 513-22. https://doi.org/10.1053/j.ajkd.2011.11.044
O'Hare AM, et al. Trajectories of Kidney Function Decline in the 2 Years Before Initiation of Long-term Dialysis. Am J Kidney Dis. 2012;59(4):513-22. PubMed PMID: 22305760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. AU - O'Hare,Ann M, AU - Batten,Adam, AU - Burrows,Nilka Ríos, AU - Pavkov,Meda E, AU - Taylor,Leslie, AU - Gupta,Indra, AU - Todd-Stenberg,Jeff, AU - Maynard,Charles, AU - Rodriguez,Rudolph A, AU - Murtagh,Fliss E M, AU - Larson,Eric B, AU - Williams,Desmond E, Y1 - 2012/02/04/ PY - 2011/08/09/received PY - 2011/11/29/accepted PY - 2012/2/7/entrez PY - 2012/2/7/pubmed PY - 2012/7/3/medline SP - 513 EP - 22 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 59 IS - 4 N2 - BACKGROUND: Little is known about patterns of kidney function decline leading up to the initiation of long-term dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 5,606 Veterans Affairs patients who initiated long-term dialysis in 2001-2003. PREDICTOR: Trajectory of estimated glomerular filtration rate (eGFR) during the 2-year period before initiation of long-term dialysis. OUTCOMES & MEASUREMENTS: Patient characteristics and care practices before and at the time of dialysis initiation and survival after initiation. RESULTS: We identified 4 distinct trajectories of eGFR during the 2-year period before dialysis initiation: 62.8% of patients had persistently low level of eGFR < 30 mL/min/1.73 m2 (mean eGFR slope, 7.7 ± 4.7 [SD] mL/min/1.73 m2 per year), 24.6% had progressive loss of eGFR from levels of approximately 30-59 ml/min/1.73 m2 (mean eGFR slope, 16.3 ± 7.6 mL/min/1.73 m2 per year), 9.5% had accelerated loss of eGFR from levels > 60 mL/min/1.73 m2 (mean eGFR slope, 32.3 ± 13.4 mL/min/1.73 m2 per year), and 3.1% experienced catastrophic loss of eGFR from levels > 60 mL/min/1.73 m2 within 6 months or less. Patients with steeper eGFR trajectories were more likely to have been hospitalized and have an inpatient diagnosis of acute kidney injury. They were less likely to have received recommended predialysis care and had a higher risk of death in the first year after dialysis initiation. CONCLUSIONS: There is substantial heterogeneity in patterns of kidney function loss leading up to the initiation of long-term dialysis perhaps calling for a more flexible approach toward preparing for end-stage renal disease. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/22305760/Trajectories_of_kidney_function_decline_in_the_2_years_before_initiation_of_long_term_dialysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(12)00026-1 DB - PRIME DP - Unbound Medicine ER -