Publication: Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients
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Issued Date
2020
Resource Type
File Type
application/pdf
ISSN
9310509
Other identifier(s)
2-s2.0-85092680717
Rights Holder(s)
Scopus
Bibliographic Citation
Nephrology Dialysis Transplantation. Vol 35, No.10 (2020), p.1786-1793
Suggested Citation
Lertdumrongluk P., Tantisattamo E., Obi Y., Nguyen H.A., Kovesdy C.P., Rhee C.M., Kalantar-Zadeh K., Streja E. Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients. Nephrology Dialysis Transplantation. Vol 35, No.10 (2020), p.1786-1793. doi:10.1093/ndt/gfaa055 Retrieved from: https://hdl.handle.net/20.500.14740/4360
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. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Subject(s)
Aged
Chronic kidney failure
Disease exacerbation
Female
Glomerulus filtration rate
Hemodialysis
Human
Kidney
Male
Middle aged
Mortality
Pathophysiology
Prognosis
Retrospective study
Survival rate
Aged
Disease Progression
Female
Glomerular Filtration Rate
Humans
Kidney
Kidney Failure, Chronic
Male
Middle Aged
Prognosis
Renal Dialysis
Retrospective Studies
Survival Rate
Chronic kidney failure
Disease exacerbation
Female
Glomerulus filtration rate
Hemodialysis
Human
Kidney
Male
Middle aged
Mortality
Pathophysiology
Prognosis
Retrospective study
Survival rate
Aged
Disease Progression
Female
Glomerular Filtration Rate
Humans
Kidney
Kidney Failure, Chronic
Male
Middle Aged
Prognosis
Renal Dialysis
Retrospective Studies
Survival Rate