title: Decline in glomerular filtration rate during pre-dialysis phase and survival on chronic renal replacement therapy.
abstract: BACKGROUND
  Estimated glomerular filtration rate (eGFR) is widely used in follow-up and assessment of patients before start of chronic renal replacement therapy (RRT). Reported data on impact of eGFR decline pattern during pre-dialysis phase on consequent survival on RRT are, however, non-existent.
  
  
  METHODS
  Using the database of the Finnish Registry for Kidney Diseases, we conducted a cohort study of all incident adult patients (n = 457) entering chronic RRT in Finland in 1998, with follow-up until 31 December 2008. We included those (n = 319) with three serum creatinine measurements (at ∼12 and 3 months and 1 to 2 weeks prior to RRT start) and calculated their slopes of eGFR using the modification of diet in renal disease formula. According to eGFR slopes (in mL/min/1.73m(2)/year), patients were divided into tertiles: most rapid (>8.5, n = 107), intermediate (3.4-8.5, n = 107) and slowest decline (<3.4, n = 105).
  
  
  RESULTS
  Median survival time was 5.6 (95% confidence interval 4.2-7.0) years. Compared to the patient group with the slowest eGFR decline, age- and gender-adjusted relative risk of death was 1.1 (0.8-1.5) in the intermediate group and 1.7 (1.2-2.4, P = 0.002) in the most rapid decline group. When further adjusting for kidney disease diagnosis, comorbidities, use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, body mass index, blood haemoglobin and serum albumin, the association was no longer significant.
  
  
  CONCLUSIONS
  Rapid decline in eGFR before entering chronic RRT associates with increased mortality on RRT. The elevated mortality appears to be caused by known risk factors for death on RRT.
authors.affiliation: Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland. mikko.haapio@helsinki.fi
authors.forename: Mikko
authors.initials: M
authors.lastname: Haapio
authors.forename: Jaakko
authors.initials: J
authors.lastname: Helve
authors.forename: Pia
authors.initials: P
authors.lastname: Kurimo
authors.forename: Terje
authors.initials: T
authors.lastname: Forslund
authors.forename: Carola
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D017582:Renal Replacement Therapy / Q000401:mortality*; D012306:Risk; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine