Original InvestigationPathogenesis and Treatment of Kidney DiseaseTrajectories of Kidney Function Decline in the 2 Years Before Initiation of Long-term Dialysis
Section snippets
Patients and Data Sources
We used data from the Veterans Affairs (VA) and the US Renal Data System (USRDS)16 to identify 6,253 patients 18 years and older who initiated long-term dialysis between October 1, 2001, and December 31, 2003 (more recent USRDS data are not currently available for veteran cohorts) and had at least one serum creatinine measurement at a VA medical center within 45 days of dialysis initiation. Of these, we identified a subset of 5,742 (87%) patients with at least 2 serum creatinine measurements
Results
For the 5,606 cohort members, there were a median of 20 (25th-75th percentile, 12-34) serum creatinine measurements during the 2-year period before dialysis initiation. On average, patients had at least one serum creatinine measurement in 5 of the 8 quarters before initiation. The median eGFR slope for all cohort members was 10 (25th-75th percentiles, 5.8 to 16.6) mL/min/1.73 m2 per year. We identified 4 distinct trajectories of eGFR among members of this cohort (Fig 1; Table 1). Most patients
Discussion
Among members of a large integrated health system, there was a substantial degree of heterogeneity in patterns of eGFR loss during the 2-year period leading to the initiation of long-term dialysis. Trajectories of eGFR before dialysis initiation were associated strongly with care practices at and before the time of initiation and with mortality during the first year after initiation.
To our knowledge, this is the first study to comprehensively describe patterns of eGFR loss preceding the
Acknowledgements
We thank Ms Whitney Showalter of the VA Puget Sound Healthcare System (VAPSHCS) for providing study coordination and administrative support for this project.
Support: This work was supported by an Interagency Agreement between the Centers for Disease Control and Prevention (CDC) and VAPSHCS (07FED69212), the VA Puget Sound Health Services Research and Development Center of Excellence, and a Beeson Career Development Award from the National Institute on Aging to Dr O'Hare (K 1K23AG28980). The
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Originally published online February 10, 2012.