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Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients.
Nephrol Dial Transplant. 2020 10 01; 35(10):1786-1793.ND

Abstract

BACKGROUND

Higher estimated glomerular filtration rate (eGFR) at dialysis initiation, known as earlier start of dialysis, is often a surrogate of poor outcomes including higher mortality. We hypothesized that earlier dialysis initiation is associated with a faster decline in residual kidney function (RKF), which is also associated with higher mortality among incident hemodialysis (HD) patients.

METHODS

In a cohort of 4911 incident HD patients who initiated HD over a 5-year period (July 2001 to June 2006), we examined the trajectories of RKF, ascertained by renal urea clearance (KRU), over 2 years after HD initiation across strata of eGFR at HD initiation using case-mix adjusted linear mixed-effect models. We then investigated the association between annual change in RKF and mortality using Cox proportional hazard models.

RESULTS

The median (interquartile range) baseline KRU was 2.20 (1.13-3.63) mL/min/1.73 m2. The decline of KRU was faster in patients who initiated HD at higher eGFR. The relative changes with 95% confidence intervals (CIs) in KRU at 1 year after HD initiation were -1.29 (-1.28 to -1.30), -1.17 (-1.16 to -1.18), -1.11 (-1.10 to -1.12) and -0.78 (-0.78 to -0.79) mL/min/1.73 m2 in the eGFR categories of ≥10, 8-<10, 6-<8 and <6 mL/min/1.73 m2, respectively. The faster decline of KRU at 1 year was associated with higher all-cause mortality (reference: ≥0 mL/min/1.73 m2): hazard ratios (95% CIs) for change in KRU of -1.5 to <0, -3 to less than -1.5 and less than -3 mL/min/1.73 m2 were 1.20 (1.03-1.40), 1.42 (1.17-1.72) and 1.88 (1.47-2.40), respectively.

CONCLUSIONS

The faster decline of RKF happens with earlier dialysis initiation and is associated with higher all-cause mortality.

Authors+Show Affiliations

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA. Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32388562

Citation

Lertdumrongluk, Paungpaga, et al. "Estimated Glomerular Filtration Rate at Dialysis Initiation and Subsequent Decline in Residual Kidney Function Among Incident Hemodialysis Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 35, no. 10, 2020, pp. 1786-1793.
Lertdumrongluk P, Tantisattamo E, Obi Y, et al. Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients. Nephrol Dial Transplant. 2020;35(10):1786-1793.
Lertdumrongluk, P., Tantisattamo, E., Obi, Y., Nguyen, H. A., Kovesdy, C. P., Rhee, C. M., Kalantar-Zadeh, K., & Streja, E. (2020). Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 35(10), 1786-1793. https://doi.org/10.1093/ndt/gfaa055
Lertdumrongluk P, et al. Estimated Glomerular Filtration Rate at Dialysis Initiation and Subsequent Decline in Residual Kidney Function Among Incident Hemodialysis Patients. Nephrol Dial Transplant. 2020 10 1;35(10):1786-1793. PubMed PMID: 32388562.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients. AU - Lertdumrongluk,Paungpaga, AU - Tantisattamo,Ekamol, AU - Obi,Yoshitsugu, AU - Nguyen,Hoang Anh, AU - Kovesdy,Csaba P, AU - Rhee,Connie M, AU - Kalantar-Zadeh,Kamyar, AU - Streja,Elani, PY - 2019/09/25/received PY - 2020/02/19/accepted PY - 2020/5/11/pubmed PY - 2021/1/13/medline PY - 2020/5/11/entrez KW - GFR KW - MDRD KW - dialysis KW - hemodialysis KW - predialysis SP - 1786 EP - 1793 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 35 IS - 10 N2 - BACKGROUND: Higher estimated glomerular filtration rate (eGFR) at dialysis initiation, known as earlier start of dialysis, is often a surrogate of poor outcomes including higher mortality. We hypothesized that earlier dialysis initiation is associated with a faster decline in residual kidney function (RKF), which is also associated with higher mortality among incident hemodialysis (HD) patients. METHODS: In a cohort of 4911 incident HD patients who initiated HD over a 5-year period (July 2001 to June 2006), we examined the trajectories of RKF, ascertained by renal urea clearance (KRU), over 2 years after HD initiation across strata of eGFR at HD initiation using case-mix adjusted linear mixed-effect models. We then investigated the association between annual change in RKF and mortality using Cox proportional hazard models. RESULTS: The median (interquartile range) baseline KRU was 2.20 (1.13-3.63) mL/min/1.73 m2. The decline of KRU was faster in patients who initiated HD at higher eGFR. The relative changes with 95% confidence intervals (CIs) in KRU at 1 year after HD initiation were -1.29 (-1.28 to -1.30), -1.17 (-1.16 to -1.18), -1.11 (-1.10 to -1.12) and -0.78 (-0.78 to -0.79) mL/min/1.73 m2 in the eGFR categories of ≥10, 8-<10, 6-<8 and <6 mL/min/1.73 m2, respectively. The faster decline of KRU at 1 year was associated with higher all-cause mortality (reference: ≥0 mL/min/1.73 m2): hazard ratios (95% CIs) for change in KRU of -1.5 to <0, -3 to less than -1.5 and less than -3 mL/min/1.73 m2 were 1.20 (1.03-1.40), 1.42 (1.17-1.72) and 1.88 (1.47-2.40), respectively. CONCLUSIONS: The faster decline of RKF happens with earlier dialysis initiation and is associated with higher all-cause mortality. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/32388562/Estimated_glomerular_filtration_rate_at_dialysis_initiation_and_subsequent_decline_in_residual_kidney_function_among_incident_hemodialysis_patients_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfaa055 DB - PRIME DP - Unbound Medicine ER -