Examining determinants of patient outcome in a low clearance clinic

With an aging population and limited resources, the incidence and prevalence of chronic kidney disease is increasing. We aimed at assessing the impact of the low clearance clinic (LCC) on not only the natural history of patients with deteriorating renal function but also the timing of renal replacement therapy (RRT) and mortality.

A retrospective cohort study involving 271 patients who entered the LCC at Hull from July 2007 to December 2010 was conducted. Descriptive analysis based on baseline characteristics was performed and slope-estimated glomerular function rates (eGFR) before and after entry to the LCC were calculated. This aided survival analysis using quartiles and Kaplan-Meier. The change in slope eGFR was the study primary end point, but secondary end points, including mortality and time to RRT, were also measured.

The average length of time within the LCC was 14 months and of those receiving RRT, 61% received this intervention within one year compared with 38% after 1 year. The rapidly declining rate of eGFR prior to entry into the LCC was predictive of both those who would need haemodialysis sooner within a mean of 21 months and of mortality within an average of 26.3 months. Slope eGFRs before and after entry into the LCC showed that 63.3% of patients improved on entry into the LCC.

The LCC impacts the rate of decline in eGFR. A rapidly declining eGFR prior to entering the LCC was predictive of RRT requirement. There was no significant impact on mortality.