title: Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease.
abstract: In patients with advanced (estimated glomerular filtration rate <25 mL/min/1.73 m2) non-dialysis-dependent chronic kidney disease (CKD) the optimal transition of care to renal replacement therapy (RRT), i.e. dialysis or transplantation, is not known. Mortality and hospitalization risk are extremely high upon transition and in the first months following the transition to dialysis. Major knowledge gaps persist pertaining to differential or individualized transitions across different demographics and clinical measures during the 'prelude' period prior to the transition, particularly in several key areas: (i) the best timing for RRT transition; (ii) the optimal RRT type (dialysis versus transplant), and in the case of dialysis, the best modality (hemodialysis versus peritoneal dialysis), format (in-center versus home), frequency (infrequent versus thrice-weekly versus more frequent) and vascular access preparation; (iii) the post-RRT impact of pre-RRT prelude conditions and events such as blood pressure and glycemic control, acute kidney injury episodes, and management of CKD-specific conditions such as anemia and mineral disorders; and (iv) the impact of the above prelude conditions on end-of-life care and RRT decision-making versus conservative management of CKD. Given the enormous changes occurring in the global CKD healthcare landscape, as well as the high costs of transitioning to dialysis therapy with persistently poor outcomes, there is an urgent need to answer these important questions. This review describes the key concepts and questions related to the emerging field of 'Transition of Care in CKD', systematically defines six main categories of CKD transition, and reviews approaches to data linkage and novel prelude analyses along with clinical applications of these studies.
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.|VA Long Beach Healthcare System, Long Beach, CA, USA.|Los Angeles Biomedical Research Institute, Harbor-UCLA Med. Center, Torrance, CA, USA.|Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.|Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.|VA Long Beach Healthcare System, Long Beach, CA, USA.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.|VA Long Beach Healthcare System, Long Beach, CA, USA.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Rhee
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Soohoo
authors.affiliation: VA Long Beach Healthcare System, Long Beach, CA, USA.
authors.forename: Joline L T
authors.initials: JLT
authors.lastname: Chen
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.affiliation: University of California Irvine Program for Public Health, Irvine, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gillen
authors.affiliation: General Internal Medicine, University of California Irvine Medical Center, Orange, CA, USA.|Biostatistics, Epidemiology and Research Design, University of California Irvine, Irvine, CA, USA.
authors.forename: Danh V
authors.initials: DV
authors.lastname: Nguyen
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.affiliation: Kaiser Permanente of Southern California, Pasadena, CA, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
authors.affiliation: Kaiser Permanente of Southern California, Pasadena, CA, USA.
authors.forename: Steve S
authors.initials: SS
authors.lastname: Jacobsen
mesh_terms: D019468:Disease Management; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D057216:Propensity Score; D006435:Renal Dialysis; D017582:Renal Replacement Therapy
keywords: advanced chronic kidney disease; prelude; renal replacement therapy; transition; vintage