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Abstract: FR-PO549

Pre-ESRD 24 Hour Urine Creatinine Changes and Post-ESRD Mortality

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Chiu, Chi-Yang, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Naseer, Adnan, Memphis VA Medical Center, Memphis, Tennessee, United States
  • Akbilgic, Oguz, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Soohoo, Melissa, University of California at Irvine, Orange, California, United States
  • Streja, Elani, University of California at Irvine, Orange, California, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California at Irvine, Orange, California, United States
Background

Protein-energy wasting (PEW) is common in CKD and ESRD. The temporal dynamics of PEW in patients with progressive loss of kidney function, and its association with future outcomes, is unclear.

Methods

We examined changes in 24-hour urine creatinine (24hrUC; a surrogate of muscle mass) over the last 3 years prior to renal replacement therapy in a national cohort of 701 incident ESRD US veterans with 2 or more 24hrUC measurements. We estimated 24hrUC slopes in mixed effects models, and we examined their association with post-dialysis all-cause mortality using Cox models adjusted for confounders. To assess the temporal dynamics of pre-ESRD changes in 24hrUC and its association with changing eGFR, we separately fitted in mixed effects models penalized spline regressions of 24hrUC on time and on eGFR.

Results

Patients were 63±10 years old, 97% male, 35% African-American. Mean baseline eGFR and 24hrUC were 26±16 ml/min/1.73m2 and 1294±290 mg, respectively. The mean slope of 24hrUC vs. time was -77±45 mg/year. Decline in 24hrUC started to accelerate in the last 2 years prior to ESRD, and once eGFR was <25 ml/min/1.73m2 (Figure). 444 patients died (mortality rate 191/1000 patient-years, 95%CI: 174-209) over a median follow-up time of 3 years. More severe decreases in 24hrUC were associated with higher mortality (Figure).

Conclusion

Patients with advanced CKD lose an average of 6% of their muscle mass each year. Loss of muscle mass starts to accelerate once eGFR falls below 25 ml/min/1.73m2, and more loss of muscle mass is associated with higher mortality after ESRD transition.

Funding

  • NIDDK Support