title: Association of Slopes of Estimated Glomerular Filtration Rate With Post-End-Stage Renal Disease Mortality in Patients With Advanced Chronic Kidney Disease Transitioning to Dialysis.
abstract: OBJECTIVE
  To investigate the association of estimated glomerular filtration rate (eGFR) slopes before dialysis initiation with cause-specific mortality after dialysis initiation.
  
  
  METHODS
  In this retrospective cohort study of 18,874 US veterans who had transitioned to dialysis from October 1, 2007, through September 30, 2011, we examined the association of pre-end-stage renal disease (ESRD) eGFR slopes with all-cause, cardiovascular, and infection-related mortality during the post-ESRD period over a median follow-up of 2.0 years (interquartile range, 1.1-3.2 years). Associations were examined using Cox models with adjustment for potential confounders.
  
  
  RESULTS
  Before the 18,874 patients transitioned to dialysis, 4485 (23.8%), 5633 (29.8%), and 7942 (42.1%) experienced fast, moderate, and slow eGFR decline, respectively, and 814 (4.3%) had increasing eGFR (defined as eGFR slopes of less than -10, -10 to less than -5, -5 to <0, and ≥0 mL/min per 1.73 m(2) per year). During the study period, a total of 9744 all-cause, 2702 cardiovascular, and 604 infection-related deaths were observed. Compared with patients with slow eGFR decline, those with moderate and fast eGFR decline had a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.06; 95% CI, 1.00-1.11; and HR, 1.11; 95% CI, 1.04-1.18, respectively) and cardiovascular mortality (HR, 1.11; 95% CI, 1.01-1.23 and HR, 1.13; 95% CI, 1.00-1.27, respectively). In contrast, increasing eGFR was only associated with higher infection-related mortality (HR, 1.49; 95% CI, 1.03-2.17).
  
  
  CONCLUSIONS
  Rapid eGFR decline is associated with higher all-cause and cardiovascular mortality, and increasing eGFR is associated with higher infection-related mortality among incident dialysis cases.
authors: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors: Keiichi
authors: K
authors: Sumida
authors: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors: Miklos Z
authors: MZ
authors: Molnar
authors: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors: Praveen K
authors: PK
authors: Potukuchi
authors: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors: Fridtjof
authors: F
authors: Thomas
authors: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors: Jun Ling
authors: JL
authors: Lu
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange.
authors: Jennie
authors: J
authors: Jing
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange.
authors: Vanessa A
authors: VA
authors: Ravel
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange.
authors: Melissa
authors: M
authors: Soohoo
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange.
authors: Connie M
authors: CM
authors: Rhee
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange.
authors: Elani
authors: E
authors: Streja
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange; Veterans Affairs Long Beach Healthcare System, Long Beach, CA.
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
authors: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis; Nephrology Section, Memphis VA Medical Center, Memphis, TN. Electronic address: ckovesdy@uthsc.edu.
authors: Csaba P
authors: CP
authors: Kovesdy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology