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End-stage renal disease preceded by rapid declines in kidney function: a case series
Peter Lee1, Kirsten Johansen, Chi-yuan Hsu
1Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA.
A significant number of patients with chronic kidney disease (CKD) experience a rapid decline in kidney function, leading to end-stage renal disease (ESRD). This rapid decline may be an under-recognized pathway to ESRD.
Area of Science:
- Nephrology
- Renal Medicine
- Public Health
Background:
- Limited understanding of diverse pathways leading to end-stage renal disease (ESRD).
- Chronic kidney disease (CKD) progression to ESRD is not fully characterized.
Purpose of the Study:
- To investigate the prevalence of rapid kidney function decline preceding ESRD.
- To identify alternate transition pathways from CKD to ESRD.
Main Methods:
- Retrospective analysis of incident dialysis patients at two Northern California units.
- Defined rapid kidney function decline as estimated GFR > 30 ml/min/1.73 m2 within three months of dialysis initiation.
Main Results:
- 7.6% and 12.7% of incident dialysis patients experienced rapid kidney function decline.
- All patients with rapid decline initiated hemodialysis via catheters.
- Pre-ESRD health status documentation was often incomplete.
Conclusions:
- Rapid kidney function decline is a significant, under-appreciated pathway to ESRD.
- This highlights the need for better characterization of CKD progression.
- Improved documentation of pre-ESRD status is crucial.
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