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Association of Slopes of Estimated Glomerular Filtration Rate With Post–End-Stage Renal Disease Mortality in Patients With Advanced Chronic Kidney Disease Transitioning to Dialysis

      Abstract

      Objective

      To investigate the association of estimated glomerular filtration rate (eGFR) slopes before dialysis initiation with cause-specific mortality after dialysis initiation.

      Patients and Methods

      In this retrospective cohort study of 18,874 US veterans who had transitioned to dialysis from October 1, 2007, through September 30, 2011, we examined the association of pre–end-stage renal disease (ESRD) eGFR slopes with all-cause, cardiovascular, and infection-related mortality during the post-ESRD period over a median follow-up of 2.0 years (interquartile range, 1.1-3.2 years). Associations were examined using Cox models with adjustment for potential confounders.

      Results

      Before the 18,874 patients transitioned to dialysis, 4485 (23.8%), 5633 (29.8%), and 7942 (42.1%) experienced fast, moderate, and slow eGFR decline, respectively, and 814 (4.3%) had increasing eGFR (defined as eGFR slopes of less than −10, −10 to less than −5, −5 to <0, and ≥0 mL/min per 1.73 m2 per year). During the study period, a total of 9744 all-cause, 2702 cardiovascular, and 604 infection-related deaths were observed. Compared with patients with slow eGFR decline, those with moderate and fast eGFR decline had a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.06; 95% CI, 1.00-1.11; and HR, 1.11; 95% CI, 1.04-1.18, respectively) and cardiovascular mortality (HR, 1.11; 95% CI, 1.01-1.23 and HR, 1.13; 95% CI, 1.00-1.27, respectively). In contrast, increasing eGFR was only associated with higher infection-related mortality (HR, 1.49; 95% CI, 1.03-2.17).

      Conclusion

      Rapid eGFR decline is associated with higher all-cause and cardiovascular mortality, and increasing eGFR is associated with higher infection-related mortality among incident dialysis cases.

      Abbreviations and Acronyms:

      AKI (acute kidney injury), BMI (body mass index), CKD (chronic kidney disease), CMS (Centers for Medicare and Medicaid Services), eGFR (estimated glomerular filtration rate), ESA (erythropoiesis-stimulating agent), ESRD (end-stage renal disease), HR (hazard ratio), IQR (interquartile range), NDD (non–dialysis dependent), PY (patient-year), USRDS (United States Renal Data System), VA (Veterans Affairs)
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