Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis.
BACKGROUND
Little is known about patterns of kidney function decline leading up to the initiation of long-term dialysis.


METHODS
Retrospective cohort study.


METHODS
5,606 Veterans Affairs patients who initiated long-term dialysis in 2001-2003.


METHODS
Trajectory of estimated glomerular filtration rate (eGFR) during the 2-year period before initiation of long-term dialysis.


METHODS
Patient characteristics and care practices before and at the time of dialysis initiation and survival after initiation.


RESULTS
We identified 4 distinct trajectories of eGFR during the 2-year period before dialysis initiation: 62.8% of patients had persistently low level of eGFR < 30 mL/min/1.73 m2 (mean eGFR slope, 7.7 ± 4.7 [SD] mL/min/1.73 m2 per year), 24.6% had progressive loss of eGFR from levels of approximately 30-59 ml/min/1.73 m2 (mean eGFR slope, 16.3 ± 7.6 mL/min/1.73 m2 per year), 9.5% had accelerated loss of eGFR from levels > 60 mL/min/1.73 m2 (mean eGFR slope, 32.3 ± 13.4 mL/min/1.73 m2 per year), and 3.1% experienced catastrophic loss of eGFR from levels > 60 mL/min/1.73 m2 within 6 months or less. Patients with steeper eGFR trajectories were more likely to have been hospitalized and have an inpatient diagnosis of acute kidney injury. They were less likely to have received recommended predialysis care and had a higher risk of death in the first year after dialysis initiation.


CONCLUSIONS
There is substantial heterogeneity in patterns of kidney function loss leading up to the initiation of long-term dialysis perhaps calling for a more flexible approach toward preparing for end-stage renal disease.
Department of Medicine, VA Puget Sound Healthcare System and University of Washington, Seattle, WA 98108, USA. ann.ohare@va.gov
Ann M
AM
O'Hare
Adam
A
Batten
Nilka Ríos
NR
Burrows
Meda E
ME
Pavkov
Leslie
L
Taylor
Indra
I
Gupta
Jeff
J
Todd-Stenberg
Charles
C
Maynard
Rudolph A
RA
Rodriguez
Fliss E M
FE
Murtagh
Eric B
EB
Larson
Desmond E
DE
Williams
D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors