Abstract
BackgroundFew studies have defined alternate pathways by which chronic kidney disease (CKD) patients transition into end-stage renal disease (ESRD).MethodsWe studied all consecutive patients initiated on maintenance hemodialysis or peritoneal dialysis over several years at two dialysis units in Northern California. Rapid decline in kidney function was considered to have occurred if a patient was documented to have estimated GFR > 30 ml/min/1.73 m2 within three months prior to the initiation of chronic dialysis.ResultsWe found that 8 out of 105 incident chronic dialysis patients one dialysis unit (7.6%; 95% confidence interval 3.4-14.5%) and 9 out of 71 incident patients at another (12.7%, 95% CI 6.0%-22.7%) suffered rapid decline in kidney function that was the immediate precipitant for the need for permanent renal replacement therapy. All these patients started hemodialysis and all relied on catheters for vascular access. Documentation submitted to United States Renal Data System did not fully reflect the health status of these patients during their "pre-ESRD" period.ConclusionsA sizeable minority of ESRD cases are preceded by rapid declines in kidney function. The importance of these periods of rapid decline may have been under-appreciated in prior studies of the natural history of CKD and ESRD.
Highlights
Few studies have defined alternate pathways by which chronic kidney disease (CKD) patients transition into end-stage renal disease (ESRD)
Background there is a large body of epidemiology literature on patients with end-stage renal disease (ESRD)–and in the past decade, on patients with chronic kidney disease (CKD)–relatively few studies have focused on the transition from CKD to ESRD
The study population consisted of consecutive patients initiated on chronic maintenance dialysis between October 2005 and December 2007 at California Pacific Medical Center (CPMC) Pacific Campus outpatient dialysis unit as well as consecutive patients initiated between January 2005 to December 2009 at San Francisco Veterans Affairs Medical Center (SFVAMC)
Summary
Few studies have defined alternate pathways by which chronic kidney disease (CKD) patients transition into end-stage renal disease (ESRD). We hypothesize based on our clinical experience that in a sizable minority of incident ESRD patients develop ESRD after suffering period of rapid loss of glomerular filtration rate (GFR) which may or may not fit the current definition of acute kidney injury (abrupt rise in serum creatinine of ≥0.3 mg/dl or ≥50% within 48 hours)[1]. This has a number of clinical and policy implications which we believe deserve consideration. The purpose of this study is to quantify the frequency with which chronic dialysis was precipitated by periods of rapid decline in kidney function at two dialysis units in Northern California, USA
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