Abrupt Decline in Kidney Function Precipitating Initiation of Chronic Renal Replacement Therapy

Csaba Kovesdy, Adnan Naseer, Keiichi Sumida, Miklos Z. Molnar, Praveen K. Potukuchi, Fridtjof Thomas, Elani Streja, Michael Heung, Kevin C. Abbott, Rajiv Saran, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

Abstract

Introduction: Abrupt declines in kidney function often occur in patients with advanced chronic kidney disease and may exacerbate the need to initiate dialysis treatment. It is unclear how frequently such events occur in patients transitioning to chronic dialysis therapy, and what outcomes they are associated with. Methods: We examined a national cohort of 23,349 US veterans with incident end-stage renal disease (ESRD) and with available pre-ESRD estimated glomerular filtration rate (eGFR) to identify abrupt declines in kidney function, defined as an unexpected >50% decrease in eGFR at the time of chronic dialysis transition. Associations with all-cause mortality and with renal recovery were examined in Cox proportional hazard and competing risk regression models. Results: A total of 4804 (21%) patients experienced an abrupt decline in kidney function at dialysis transition. Renal recovery occurred in 586 (12.2%) and 297 (1.6%) patients with and without an abrupt decline, respectively (adjusted subhazard ratio: 4.42; 95% confidence interval [CI]: 3.72–5.27; P < 0.001). In the first 6 months after dialysis transition 1178 patients (24.5%) with abrupt decline died (annualized mortality rate 574/1000 patient-years), compared with 2354 deaths (12.7%) in patients without abrupt decline (274 deaths/1000 patient-years). An abrupt decline was associated with 45% higher mortality after multivariable adjustments (hazard ratio: 1.45; 95% CI: 1.33–1.57). Conclusion: Abrupt declines in kidney function are common in patients transitioning to chronic dialysis, and are associated with higher mortality. Patients with abrupt declines also experience a higher rate of renal recovery; hence, careful attention to residual kidney function is warranted in these patients.

LanguageEnglish (US)
Pages602-609
Number of pages8
JournalKidney International Reports
Volume3
Issue number3
DOIs
StatePublished - May 1 2018

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Renal Replacement Therapy
Kidney
Dialysis
Mortality
Glomerular Filtration Rate
Chronic Kidney Failure
Confidence Intervals
Patient Transfer
Veterans
Chronic Renal Insufficiency

All Science Journal Classification (ASJC) codes

  • Nephrology

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Abrupt Decline in Kidney Function Precipitating Initiation of Chronic Renal Replacement Therapy. / Kovesdy, Csaba; Naseer, Adnan; Sumida, Keiichi; Molnar, Miklos Z.; Potukuchi, Praveen K.; Thomas, Fridtjof; Streja, Elani; Heung, Michael; Abbott, Kevin C.; Saran, Rajiv; Kalantar-Zadeh, Kamyar.

In: Kidney International Reports, Vol. 3, No. 3, 01.05.2018, p. 602-609.

Research output: Contribution to journalArticle

Kovesdy, C, Naseer, A, Sumida, K, Molnar, MZ, Potukuchi, PK, Thomas, F, Streja, E, Heung, M, Abbott, KC, Saran, R & Kalantar-Zadeh, K 2018, 'Abrupt Decline in Kidney Function Precipitating Initiation of Chronic Renal Replacement Therapy' Kidney International Reports, vol. 3, no. 3, pp. 602-609. https://doi.org/10.1016/j.ekir.2017.12.007
Kovesdy, Csaba ; Naseer, Adnan ; Sumida, Keiichi ; Molnar, Miklos Z. ; Potukuchi, Praveen K. ; Thomas, Fridtjof ; Streja, Elani ; Heung, Michael ; Abbott, Kevin C. ; Saran, Rajiv ; Kalantar-Zadeh, Kamyar. / Abrupt Decline in Kidney Function Precipitating Initiation of Chronic Renal Replacement Therapy. In: Kidney International Reports. 2018 ; Vol. 3, No. 3. pp. 602-609.
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AU - Naseer, Adnan

AU - Sumida, Keiichi

AU - Molnar, Miklos Z.

AU - Potukuchi, Praveen K.

AU - Thomas, Fridtjof

AU - Streja, Elani

AU - Heung, Michael

AU - Abbott, Kevin C.

AU - Saran, Rajiv

AU - Kalantar-Zadeh, Kamyar

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N2 - Introduction: Abrupt declines in kidney function often occur in patients with advanced chronic kidney disease and may exacerbate the need to initiate dialysis treatment. It is unclear how frequently such events occur in patients transitioning to chronic dialysis therapy, and what outcomes they are associated with. Methods: We examined a national cohort of 23,349 US veterans with incident end-stage renal disease (ESRD) and with available pre-ESRD estimated glomerular filtration rate (eGFR) to identify abrupt declines in kidney function, defined as an unexpected >50% decrease in eGFR at the time of chronic dialysis transition. Associations with all-cause mortality and with renal recovery were examined in Cox proportional hazard and competing risk regression models. Results: A total of 4804 (21%) patients experienced an abrupt decline in kidney function at dialysis transition. Renal recovery occurred in 586 (12.2%) and 297 (1.6%) patients with and without an abrupt decline, respectively (adjusted subhazard ratio: 4.42; 95% confidence interval [CI]: 3.72–5.27; P < 0.001). In the first 6 months after dialysis transition 1178 patients (24.5%) with abrupt decline died (annualized mortality rate 574/1000 patient-years), compared with 2354 deaths (12.7%) in patients without abrupt decline (274 deaths/1000 patient-years). An abrupt decline was associated with 45% higher mortality after multivariable adjustments (hazard ratio: 1.45; 95% CI: 1.33–1.57). Conclusion: Abrupt declines in kidney function are common in patients transitioning to chronic dialysis, and are associated with higher mortality. Patients with abrupt declines also experience a higher rate of renal recovery; hence, careful attention to residual kidney function is warranted in these patients.

AB - Introduction: Abrupt declines in kidney function often occur in patients with advanced chronic kidney disease and may exacerbate the need to initiate dialysis treatment. It is unclear how frequently such events occur in patients transitioning to chronic dialysis therapy, and what outcomes they are associated with. Methods: We examined a national cohort of 23,349 US veterans with incident end-stage renal disease (ESRD) and with available pre-ESRD estimated glomerular filtration rate (eGFR) to identify abrupt declines in kidney function, defined as an unexpected >50% decrease in eGFR at the time of chronic dialysis transition. Associations with all-cause mortality and with renal recovery were examined in Cox proportional hazard and competing risk regression models. Results: A total of 4804 (21%) patients experienced an abrupt decline in kidney function at dialysis transition. Renal recovery occurred in 586 (12.2%) and 297 (1.6%) patients with and without an abrupt decline, respectively (adjusted subhazard ratio: 4.42; 95% confidence interval [CI]: 3.72–5.27; P < 0.001). In the first 6 months after dialysis transition 1178 patients (24.5%) with abrupt decline died (annualized mortality rate 574/1000 patient-years), compared with 2354 deaths (12.7%) in patients without abrupt decline (274 deaths/1000 patient-years). An abrupt decline was associated with 45% higher mortality after multivariable adjustments (hazard ratio: 1.45; 95% CI: 1.33–1.57). Conclusion: Abrupt declines in kidney function are common in patients transitioning to chronic dialysis, and are associated with higher mortality. Patients with abrupt declines also experience a higher rate of renal recovery; hence, careful attention to residual kidney function is warranted in these patients.

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