Kidney Week

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

• Non-Cardiovascular Outcomes in Hemodialysis
  November 04, 2017 | Location: Room 292, Morial Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Dialysis

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

Authors

• Soohoo, Melissa, UC Irvine, Orange, California, United States

Melissa Soohoo, MPH

• Streja, Elani, UC Irvine, Orange, California, United States

Elani Streja,

• Obi, Yoshitsugu, UC Irvine, Orange, California, United States

Yoshitsugu Obi,

• Rhee, Connie, UC Irvine, Orange, California, United States

Connie Rhee,

• Gillen, Daniel L., UC Irvine, Orange, California, United States

Daniel L. Gillen,

• Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan

Keiichi Sumida,

• Nguyen, Danh V., UC Irvine, Orange, California, United States

Danh V. Nguyen,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, UC Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

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