Disease Trajectories Before ESRD

Implications for Clinical Management

Keiichi Sumida, Csaba Kovesdy

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

One of the biggest challenges nephrologists face is to predict complex clinical pathways of kidney disease progression that do not follow a steady linear decline. This unpredictability often becomes a barrier to timely shared decision making between patients and physicians and could lead to adverse patient outcomes. By using numerous analytic approaches to characterize the longitudinal changes in kidney function, emerging evidence has disclosed the heterogeneous trajectories of kidney disease progression, particularly in late-stage chronic kidney disease (CKD) nearing end-stage renal disease (ESRD), and showed their independent associations with various clinical outcomes. These findings, in turn, have reinforced the importance of incorporating individual kidney disease trajectories into the clinical management of patients with late-stage CKD, which may help clarify the optimal timing of preparatory interventions, such as vascular access planning and transplant referral, and deliver better care with potential downstream benefits, such as a lower incidence of ESRD or a more seamless transition to ESRD. In this article, we review the current evidence on trajectories of kidney disease progression, particularly among patients with late-stage CKD progressing to ESRD, and discuss their implications for clinical management.

Original languageEnglish (US)
Pages (from-to)132-143
Number of pages12
JournalSeminars in Nephrology
Volume37
Issue number2
DOIs
StatePublished - Mar 1 2017

Fingerprint

Kidney Diseases
Chronic Kidney Failure
Chronic Renal Insufficiency
Disease Progression
Critical Pathways
Blood Vessels
Decision Making
Referral and Consultation
Physicians
Transplants
Kidney
Incidence

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Disease Trajectories Before ESRD : Implications for Clinical Management. / Sumida, Keiichi; Kovesdy, Csaba.

In: Seminars in Nephrology, Vol. 37, No. 2, 01.03.2017, p. 132-143.

Research output: Contribution to journalReview article

@article{33faefca47d04305b2cff5dadaa68548,
title = "Disease Trajectories Before ESRD: Implications for Clinical Management",
abstract = "One of the biggest challenges nephrologists face is to predict complex clinical pathways of kidney disease progression that do not follow a steady linear decline. This unpredictability often becomes a barrier to timely shared decision making between patients and physicians and could lead to adverse patient outcomes. By using numerous analytic approaches to characterize the longitudinal changes in kidney function, emerging evidence has disclosed the heterogeneous trajectories of kidney disease progression, particularly in late-stage chronic kidney disease (CKD) nearing end-stage renal disease (ESRD), and showed their independent associations with various clinical outcomes. These findings, in turn, have reinforced the importance of incorporating individual kidney disease trajectories into the clinical management of patients with late-stage CKD, which may help clarify the optimal timing of preparatory interventions, such as vascular access planning and transplant referral, and deliver better care with potential downstream benefits, such as a lower incidence of ESRD or a more seamless transition to ESRD. In this article, we review the current evidence on trajectories of kidney disease progression, particularly among patients with late-stage CKD progressing to ESRD, and discuss their implications for clinical management.",
author = "Keiichi Sumida and Csaba Kovesdy",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.semnephrol.2016.12.003",
language = "English (US)",
volume = "37",
pages = "132--143",
journal = "Seminars in Nephrology",
issn = "0270-9295",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Disease Trajectories Before ESRD

T2 - Implications for Clinical Management

AU - Sumida, Keiichi

AU - Kovesdy, Csaba

PY - 2017/3/1

Y1 - 2017/3/1

N2 - One of the biggest challenges nephrologists face is to predict complex clinical pathways of kidney disease progression that do not follow a steady linear decline. This unpredictability often becomes a barrier to timely shared decision making between patients and physicians and could lead to adverse patient outcomes. By using numerous analytic approaches to characterize the longitudinal changes in kidney function, emerging evidence has disclosed the heterogeneous trajectories of kidney disease progression, particularly in late-stage chronic kidney disease (CKD) nearing end-stage renal disease (ESRD), and showed their independent associations with various clinical outcomes. These findings, in turn, have reinforced the importance of incorporating individual kidney disease trajectories into the clinical management of patients with late-stage CKD, which may help clarify the optimal timing of preparatory interventions, such as vascular access planning and transplant referral, and deliver better care with potential downstream benefits, such as a lower incidence of ESRD or a more seamless transition to ESRD. In this article, we review the current evidence on trajectories of kidney disease progression, particularly among patients with late-stage CKD progressing to ESRD, and discuss their implications for clinical management.

AB - One of the biggest challenges nephrologists face is to predict complex clinical pathways of kidney disease progression that do not follow a steady linear decline. This unpredictability often becomes a barrier to timely shared decision making between patients and physicians and could lead to adverse patient outcomes. By using numerous analytic approaches to characterize the longitudinal changes in kidney function, emerging evidence has disclosed the heterogeneous trajectories of kidney disease progression, particularly in late-stage chronic kidney disease (CKD) nearing end-stage renal disease (ESRD), and showed their independent associations with various clinical outcomes. These findings, in turn, have reinforced the importance of incorporating individual kidney disease trajectories into the clinical management of patients with late-stage CKD, which may help clarify the optimal timing of preparatory interventions, such as vascular access planning and transplant referral, and deliver better care with potential downstream benefits, such as a lower incidence of ESRD or a more seamless transition to ESRD. In this article, we review the current evidence on trajectories of kidney disease progression, particularly among patients with late-stage CKD progressing to ESRD, and discuss their implications for clinical management.

UR - http://www.scopus.com/inward/record.url?scp=85011973259&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011973259&partnerID=8YFLogxK

U2 - 10.1016/j.semnephrol.2016.12.003

DO - 10.1016/j.semnephrol.2016.12.003

M3 - Review article

VL - 37

SP - 132

EP - 143

JO - Seminars in Nephrology

JF - Seminars in Nephrology

SN - 0270-9295

IS - 2

ER -