Transition of care from pre-dialysis prelude to renal replacement therapy

The blueprints of emerging research in advanced chronic kidney disease

Kamyar Kalantar-Zadeh, Csaba Kovesdy, Elani Streja, Connie M. Rhee, Melissa Soohoo, Joline L.T. Chen, Miklos Z. Molnar, Yoshitsugu Obi, Daniel Gillen, Danh V. Nguyen, Keith C. Norris, John J. Sim, Steve S. Jacobsen

Research output: Contribution to journalReview article

19 Citations (Scopus)

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 bestmodality (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 decisionmaking 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.

Original languageEnglish (US)
Pages (from-to)ii91-ii98
JournalNephrology Dialysis Transplantation
Volume32
DOIs
StatePublished - Apr 1 2017

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Patient Transfer
Renal Replacement Therapy
Chronic Renal Insufficiency
Dialysis
Research
Terminal Care
Information Storage and Retrieval
Peritoneal Dialysis
Glomerular Filtration Rate
Acute Kidney Injury
Minerals
Blood Vessels
Renal Dialysis
Anemia
Hospitalization
Transplantation
Demography
Blood Pressure
Delivery of Health Care
Transplants

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Transition of care from pre-dialysis prelude to renal replacement therapy : The blueprints of emerging research in advanced chronic kidney disease. / Kalantar-Zadeh, Kamyar; Kovesdy, Csaba; Streja, Elani; Rhee, Connie M.; Soohoo, Melissa; Chen, Joline L.T.; Molnar, Miklos Z.; Obi, Yoshitsugu; Gillen, Daniel; Nguyen, Danh V.; Norris, Keith C.; Sim, John J.; Jacobsen, Steve S.

In: Nephrology Dialysis Transplantation, Vol. 32, 01.04.2017, p. ii91-ii98.

Research output: Contribution to journalReview article

Kalantar-Zadeh, K, Kovesdy, C, Streja, E, Rhee, CM, Soohoo, M, Chen, JLT, Molnar, MZ, Obi, Y, Gillen, D, Nguyen, DV, Norris, KC, Sim, JJ & Jacobsen, SS 2017, 'Transition of care from pre-dialysis prelude to renal replacement therapy: The blueprints of emerging research in advanced chronic kidney disease', Nephrology Dialysis Transplantation, vol. 32, pp. ii91-ii98. https://doi.org/10.1093/ndt/gfw357
Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba ; Streja, Elani ; Rhee, Connie M. ; Soohoo, Melissa ; Chen, Joline L.T. ; Molnar, Miklos Z. ; Obi, Yoshitsugu ; Gillen, Daniel ; Nguyen, Danh V. ; Norris, Keith C. ; Sim, John J. ; Jacobsen, Steve S. / Transition of care from pre-dialysis prelude to renal replacement therapy : The blueprints of emerging research in advanced chronic kidney disease. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32. pp. ii91-ii98.
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AU - Kovesdy, Csaba

AU - Streja, Elani

AU - Rhee, Connie M.

AU - Soohoo, Melissa

AU - Chen, Joline L.T.

AU - Molnar, Miklos Z.

AU - Obi, Yoshitsugu

AU - Gillen, Daniel

AU - Nguyen, Danh V.

AU - Norris, Keith C.

AU - Sim, John J.

AU - Jacobsen, Steve S.

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N2 - 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 bestmodality (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 decisionmaking 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.

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