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- Title
Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients.
- Authors
Lertdumrongluk, Paungpaga; Tantisattamo, Ekamol; Obi, Yoshitsugu; Nguyen, Hoang Anh; Kovesdy, Csaba P; Rhee, Connie M; Kalantar-Zadeh, Kamyar; Streja, Elani
- Abstract
Background Higher estimated glomerular filtration rate (eGFR) at dialysis initiation, known as earlier start of dialysis, is often a surrogate of poor outcomes including higher mortality. We hypothesized that earlier dialysis initiation is associated with a faster decline in residual kidney function (RKF), which is also associated with higher mortality among incident hemodialysis (HD) patients. Methods In a cohort of 4911 incident HD patients who initiated HD over a 5-year period (July 2001 to June 2006), we examined the trajectories of RKF, ascertained by renal urea clearance (KRU), over 2 years after HD initiation across strata of eGFR at HD initiation using case-mix adjusted linear mixed-effect models. We then investigated the association between annual change in RKF and mortality using Cox proportional hazard models. Results The median (interquartile range) baseline KRU was 2.20 (1.13–3.63) mL/min/1.73 m2. The decline of KRU was faster in patients who initiated HD at higher eGFR. The relative changes with 95% confidence intervals (CIs) in KRU at 1 year after HD initiation were −1.29 (−1.28 to −1.30), −1.17 (−1.16 to −1.18), −1.11 (−1.10 to −1.12) and −0.78 (−0.78 to −0.79) mL/min/1.73 m2 in the eGFR categories of ≥10, 8–<10, 6–<8 and <6 mL/min/1.73 m2, respectively. The faster decline of KRU at 1 year was associated with higher all-cause mortality (reference: ≥0 mL/min/1.73 m2): hazard ratios (95% CIs) for change in KRU of −1.5 to <0, −3 to less than −1.5 and less than −3 mL/min/1.73 m2 were 1.20 (1.03–1.40), 1.42 (1.17–1.72) and 1.88 (1.47–2.40), respectively. Conclusions The faster decline of RKF happens with earlier dialysis initiation and is associated with higher all-cause mortality.
- Subjects
GLOMERULAR filtration rate; HEMODIALYSIS patients; PROPORTIONAL hazards models; KIDNEYS
- Publication
Nephrology Dialysis Transplantation, 2020, Vol 35, Issue 10, p1786
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfaa055