Past Decline Versus Current eGFR and Subsequent ESRD Risk

Kövesdy, Csaba P.; Coresh, Josef; Ballew, Shoshana H.; Woodward, Mark; Levin, Adeera; Naimark, David; Nally, Joseph V.; Rothenbacher, Dietrich; Stengel, Bénédicte; Iseki, Kunitoshi; Matsushita, Kunihiro; Levey, Andrew S.

doi:10.1681/asn.2015060687

Cited by 94 publications

(80 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The predictive value of diabetes and magnitude of proteinuria in the model is in agreement with the observation that CKD progresses faster in patients with diabetes and those with more proteinuria (20). Finally, the contribution of GFR trajectory to the predictive model is consistent with a recent investigation, which reported that both current eGFR level and the eGFR trajectory were predictors of progression to ESRD in patients with CKD (21). If our observations are confirmed in a multicenter study, they may provide a basis for a more customized approach to planning AVF placement in patients with CKD.…”

Section: Discussionsupporting

confidence: 88%

Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

View full text Add to dashboard Cite

Background and objectives The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis.Design, setting, participants, & measurements Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years.Results Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m 2 ; P,0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15; P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m 2 per year; P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U; P,0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76; P,0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88; P,0.001).Conclusions The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.

show abstract

Section: Discussionsupporting

confidence: 88%

Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

View full text Add to dashboard Cite

show abstract

“…Our study evaluated ESRD outcomes on more than 12,000 individuals with single abnormal creatinine measurements who were captured into the KPSC creatinine safety program. We were able to demonstrate higher ESRD incidence rates among those who were captured into the safety program and still higher among those who had a repeated creatinine 14,24 Our findings demonstrate that a high-risk population for CKD was indeed identified while we were able to track pertinent practice patterns and CKD-related outcomes. The main assumption is that the program will lead to interventions that result in better overall CKD and CKDrelated care.…”

Section: Discussionmentioning

confidence: 64%

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

Sim

Batech

Danforth

et al. 2017

TPJ

View full text Add to dashboard Cite

Objectives: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement.Methods: Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age-and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population.Results: Among 12,394 individuals, 83 (0.7%) reached ESRD. The age-and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p < 0.001). Screening with the Chronic Kidney Disease Epidemiology Collaboration (vs Modification Diet in Renal Diseases) equation would capture 44% fewer individuals and have a higher predictive value for CKD. Of those who had repeated creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD).Conclusion: Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

show abstract

“…However, these definitions are arbitrary and lacking in substantial evidence to support these definitions proposed. Results from a meta-analysis of 22 cohorts showed that eGFR decline slope greater than 3ml/min /1.73m 2 /year over the first 3years of CKD was significant associated with risk of ESRD (adjusted HR 1.73, 95% CI, 1.50 to 2.00)[29]. Using the data from the Alberta Kidney Disease Network (AKDN), among a cohort of 529,312 adults, the adjusted ESRD risks were 1.45, 1.53, 1.63, 1.90, 1.7 for the corresponding absolute annual rate of eGFR decline of -1, -2, -3, -4, and -5 ml/min/1.73 m 2 /year, respectively[5].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal change in estimated GFR among CKD patients: A 10-year follow-up study of an integrated kidney disease care program in Taiwan

et al. 2017

View full text Add to dashboard Cite

BackgroundThis study examined the progression of chronic kidney disease (CKD) by using average annual decline in estimated GFR (eGFR) and its risk factors in a 10-year follow-up CKD cohort.MethodsA prospective, observational cohort study, 4600 individuals fulfilled the definition of CKD, with or without proteinuria, were followed for 10 years. The eGFR was estimated by the MDRD equation. Linear regression was used to estimate participants’ annual decline rate in eGFR. We defined subjects with annual eGFR decline rate <1 ml/min/1.73 m2 as non-progression and the decline rate over 3 ml/min/1.73 m2 as rapid progression.ResultsDuring the follow-up period, 2870 (62.4%) individuals had annual eGFR decline rate greater than 1 ml/min/1.73 m2. The eGFR decline rate was slower in individuals with CKD diagnosed over the age of 60 years than those with onset at a younger age. Comparing to subjects with decline rate <1 ml/min/1.73 m2/year, the odds ratio (OR) of developing rapid CKD progression for diabetes, proteinuria and late onset of CKD was 1.72 (95% CI: 1.48–2.00), 1.89(1.63–2.20) and 0.68 (0.56–0.81), respectively. When the model was adjusted for the latest CKD stage, comparing to those with CKD stage 1, patients with stage 4 and stage 5 have significantly higher risks for rapid progression (OR, 5.17 (2.60–10.25), 19.83 (10.05–39.10), respectively). However, such risk was not observed among patients with the latest CKD stage 2 and 3. The risk for incident ESRD was 17% higher for each 1 ml/min/1.73 m2 increasing in annual decline rate.ConclusionsNot everyone with CKD develops ESRD after a 10-year follow-up. Absolute annual eGFR decline rate can help clinicians to better predict the progression of CKD. Individuals with renal function decline rate over 3 ml/min/1.73 m2/year require intensive CKD care.

show abstract

Past Decline Versus Current eGFR and Subsequent ESRD Risk

Cited by 94 publications

References 36 publications

Predictors of Initiation for Predialysis Arteriovenous Fistula

Predictors of Initiation for Predialysis Arteriovenous Fistula

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

Longitudinal change in estimated GFR among CKD patients: A 10-year follow-up study of an integrated kidney disease care program in Taiwan

Contact Info

Product

Resources

About