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Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: The Chronic Renal Insufficiency Cohort (CRIC) Study.
Am J Kidney Dis. 2016 08; 68(2):193-202.AJ

Abstract

BACKGROUND

It is not clear whether the pattern of kidney function decline in patients with chronic kidney disease (CKD) may relate to outcomes after reaching end-stage renal disease (ESRD). We hypothesize that an abrupt decline in kidney function prior to ESRD predicts early death after initiating maintenance hemodialysis therapy.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

The Chronic Renal Insufficiency Cohort (CRIC) Study enrolled men and women with mild to moderate CKD. For this study, we studied 661 individuals who developed chronic kidney failure that required hemodialysis therapy initiation.

PREDICTORS

The primary predictor was the presence of an abrupt decline in kidney function prior to ESRD. We incorporated annual estimated glomerular filtration rates (eGFRs) into a mixed-effects model to estimate patient-specific eGFRs at 3 months prior to initiation of hemodialysis therapy. Abrupt decline was defined as having an extrapolated eGFR≥30mL/min/1.73m(2) at that time point.

OUTCOMES

All-cause mortality within 1 year after initiating hemodialysis therapy.

MEASUREMENTS

Multivariable Cox proportional hazards.

RESULTS

Among 661 patients with CKD initiating hemodialysis therapy, 56 (8.5%) had an abrupt predialysis decline in kidney function and 69 died within 1 year after initiating hemodialysis therapy. After adjustment for demographics, cardiovascular disease, diabetes, and cancer, abrupt decline in kidney function was associated with a 3-fold higher risk for death within the first year of ESRD (adjusted HR, 3.09; 95% CI, 1.65-5.76).

LIMITATIONS

Relatively small number of outcomes; infrequent (yearly) eGFR determinations; lack of more granular clinical data.

CONCLUSIONS

Abrupt decline in kidney function prior to ESRD occurred in a significant minority of incident hemodialysis patients and predicted early death in ESRD.

Authors+Show Affiliations

University of California, San Francisco, San Francisco, CA. Electronic address: raymond.hsu@ucsf.edu.University of Pennsylvania, Philadelphia, PA.University of Pennsylvania, Philadelphia, PA.University of Pennsylvania, Philadelphia, PA.University of Washington, Seattle, WA.University of Pennsylvania, Philadelphia, PA.University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA; Stanford University, Stanford, CA.Tulane University, New Orleans, LA.Case Western Reserve University, Cleveland, OH.National Institutes of Health, Bethesda, MD.University of Illinois, Chicago, IL.University of Michigan, Ann Arbor, MI.Wayne State University, Detroit, MI.University of Pennsylvania, Philadelphia, PA.University of Maryland, Baltimore, MD.University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26830447

Citation

Hsu, Raymond K., et al. "Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: the Chronic Renal Insufficiency Cohort (CRIC) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 2, 2016, pp. 193-202.
Hsu RK, Chai B, Roy JA, et al. Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2016;68(2):193-202.
Hsu, R. K., Chai, B., Roy, J. A., Anderson, A. H., Bansal, N., Feldman, H. I., Go, A. S., He, J., Horwitz, E. J., Kusek, J. W., Lash, J. P., Ojo, A., Sondheimer, J. H., Townsend, R. R., Zhan, M., & Hsu, C. Y. (2016). Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: The Chronic Renal Insufficiency Cohort (CRIC) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(2), 193-202. https://doi.org/10.1053/j.ajkd.2015.12.025
Hsu RK, et al. Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2016;68(2):193-202. PubMed PMID: 26830447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: The Chronic Renal Insufficiency Cohort (CRIC) Study. AU - Hsu,Raymond K, AU - Chai,Boyang, AU - Roy,Jason A, AU - Anderson,Amanda H, AU - Bansal,Nisha, AU - Feldman,Harold I, AU - Go,Alan S, AU - He,Jiang, AU - Horwitz,Edward J, AU - Kusek,John W, AU - Lash,James P, AU - Ojo,Akinlolu, AU - Sondheimer,James H, AU - Townsend,Raymond R, AU - Zhan,Min, AU - Hsu,Chi-Yuan, AU - ,, Y1 - 2016/01/29/ PY - 2015/07/28/received PY - 2015/12/26/accepted PY - 2016/2/3/entrez PY - 2016/2/3/pubmed PY - 2017/6/1/medline KW - Chronic Renal Insufficiency Cohort (CRIC) KW - Kidney function KW - disease trajectory KW - eGFR decline KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - hemodialysis KW - mortality KW - renal replacement therapy (RRT) initiation KW - transition to ESRD SP - 193 EP - 202 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 2 N2 - BACKGROUND: It is not clear whether the pattern of kidney function decline in patients with chronic kidney disease (CKD) may relate to outcomes after reaching end-stage renal disease (ESRD). We hypothesize that an abrupt decline in kidney function prior to ESRD predicts early death after initiating maintenance hemodialysis therapy. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: The Chronic Renal Insufficiency Cohort (CRIC) Study enrolled men and women with mild to moderate CKD. For this study, we studied 661 individuals who developed chronic kidney failure that required hemodialysis therapy initiation. PREDICTORS: The primary predictor was the presence of an abrupt decline in kidney function prior to ESRD. We incorporated annual estimated glomerular filtration rates (eGFRs) into a mixed-effects model to estimate patient-specific eGFRs at 3 months prior to initiation of hemodialysis therapy. Abrupt decline was defined as having an extrapolated eGFR≥30mL/min/1.73m(2) at that time point. OUTCOMES: All-cause mortality within 1 year after initiating hemodialysis therapy. MEASUREMENTS: Multivariable Cox proportional hazards. RESULTS: Among 661 patients with CKD initiating hemodialysis therapy, 56 (8.5%) had an abrupt predialysis decline in kidney function and 69 died within 1 year after initiating hemodialysis therapy. After adjustment for demographics, cardiovascular disease, diabetes, and cancer, abrupt decline in kidney function was associated with a 3-fold higher risk for death within the first year of ESRD (adjusted HR, 3.09; 95% CI, 1.65-5.76). LIMITATIONS: Relatively small number of outcomes; infrequent (yearly) eGFR determinations; lack of more granular clinical data. CONCLUSIONS: Abrupt decline in kidney function prior to ESRD occurred in a significant minority of incident hemodialysis patients and predicted early death in ESRD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26830447/Abrupt_Decline_in_Kidney_Function_Before_Initiating_Hemodialysis_and_All_Cause_Mortality:_The_Chronic_Renal_Insufficiency_Cohort__CRIC__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)00016-0 DB - PRIME DP - Unbound Medicine ER -