Abstract: SA-OR033

Conservative Kidney Profile Prior to Transitioning to Dialysis and Early Dialysis Outcomes in US Veterans: A Transition of Care in CKD Study

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Soohoo, Melissa, UC Irvine, Orange, California, United States
  • Streja, Elani, UC Irvine, Orange, California, United States
  • Obi, Yoshitsugu, UC Irvine, Orange, California, United States
  • Rhee, Connie, UC Irvine, Orange, California, United States
  • Gillen, Daniel L., UC Irvine, Orange, California, United States
  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan
  • Nguyen, Danh V., UC Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, UC Irvine, Orange, California, United States
Background

National data has shown that more patients transition to end-stage renal disease (ESRD) at a higher estimated glomerular filtration rate (eGFR), yet mortality is high in the first months upon ESRD transition and studies have questioned the contribution of aggressive dialysis initiation to this outcome. We hypothesized that among US veterans transitioning to ESRD, a more conservative kidney profile in the pre-ESRD (prelude) period, including lower kidney function level and slower eGFR slope, is associated with better outcomes.

Methods

In 19,985 veterans transitioning to ESRD in 2007-2014, we examined the association of eGFR at transition and its slope over the final 12 months of the prelude period with 12-month post-ESRD mortality and hospitalization rates, using Cox and Poisson regression models, respectively. Two groups of low vs. high eGFR (dichotomized at 10 mL/min/1.73m2) and slow vs. fast slope (dichotomized at -10 mL/min/1.73m2/year) were combined into four groups.

Results

Patients had a median[IQR] of eGFR at transition and slope of 9.7[7.1,13.3] mL/min/1.73m2 and -10.5[-18.8,-5.9] mL/min/1.73m2/year, respectively. Patients with a conservative kidney profile (low eGFR and slow slope), had the lowest 12-month all-cause and cardiovascular (CV) mortality risks (Figure), and hospitalization rate. Conversely, patients with a high eGFR and fast slope had the highest adjusted all-cause (HR [95% CI]: 1.80 [1.62, 1.99]) and CV mortality risks (1.57 [1.32,1.88]) and hospitalization rate (IRR [95% CI] 1.39 [1.34, 1.44]) compared to conservative kidney profile patients.

Conclusion

A kidney profile characterized by slower chronic kidney disease progression and a later transition to ESRD is associated with more favorable early dialysis outcomes. Trials to examine a more conservative approach to dialysis are warranted.

Funding

  • NIDDK Support