Level of renal function at the initiation of dialysis in the U.S. end-stage renal disease population.
Level of renal function at the initiation of dialysis in the U.S. end-stage renal disease population.


BACKGROUND
More than 285,000 individuals in the United States suffer from end-stage renal disease (ESRD) and are treated predominantly by dialysis. Despite the high cost and poor outcomes of dialysis treatment for ESRD, there are few data about the level of renal function at the onset of ESRD and no established medical criteria for the initiation of dialysis.


METHODS
We report the level of serum creatinine and glomerular filtration rate (GFR) in 90,897 patients who began dialysis in the U. S. between April 1995 through September 1997. Data were obtained from the U.S. Renal Data System. GFR was predicted by an equation developed from the Modification of Diet in Renal Disease Study.


RESULTS
The mean (SD) serum creatinine was 8.5 (3.8) mg/dl. The mean (SD) predicted GFR was 7.1 (3.1) ml/min/1.73 m2, with a range from 1 to 42 ml/min/1.73 m2. The proportion of patients with predicted GFR of > 10, 5 to 10, and <5 ml/min/1.73 m2 was 14, 63, and 23%, respectively. The mean predicted GFR was significantly lower among younger patients, women, African Americans, patients with a higher body weight, patients with ESRD because of diseases other than diabetes, uninsured patients, patients who were employed, homemakers or students, and patients selecting hemodialysis.


CONCLUSIONS
There is wide variation in renal function at the initiation of dialysis in the U.S. ESRD population, and a substantial fraction of patients start dialysis at very low levels of predicted GFR. Further analyses are needed to examine the factors associated with late initiation of dialysis and its impact on the cost and outcomes of ESRD.
Obrador
G T
GT
Panamerican University School of Medicine, Mexico City, Mexico.
Arora
P
P
Kausz
A T
AT
Ruthazer
R
R
Pereira
B J
BJ
Levey
A S
AS
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000639:trends; D011237:Predictive Value of Tests; D011364:Professional Practice / Q000639:trends; D006435:Renal Dialysis / Q000639:trends*; D014481:United States
D003404:Creatinine