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Disease Trajectories Before ESRD: Implications for Clinical Management.
Keiichi Sumida1, Csaba P Kovesdy2
1Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Seminars in Nephrology
|April 16, 2017
Summary
Predicting kidney disease progression is challenging. Understanding individual patient trajectories, especially in late-stage chronic kidney disease (CKD), improves shared decision-making and patient outcomes near end-stage renal disease (ESRD).
Area of Science:
- Nephrology
- Clinical Medicine
- Biostatistics
Background:
- Kidney disease progression is often unpredictable, hindering timely clinical decisions.
- Non-linear trajectories in late-stage chronic kidney disease (CKD) impact patient outcomes.
- Current management may not fully account for heterogeneous disease pathways.
Purpose of the Study:
- To review evidence on kidney disease progression trajectories.
- To highlight the importance of individual patient pathways in late-stage CKD.
- To discuss implications for clinical management and patient care.
Main Methods:
- Analysis of longitudinal kidney function data.
- Characterization of heterogeneous disease progression patterns.
- Review of emerging evidence on CKD and end-stage renal disease (ESRD) pathways.
Main Results:
- Kidney disease progression exhibits diverse trajectories, not a steady linear decline.
- These heterogeneous trajectories are independently associated with clinical outcomes.
- Understanding individual pathways is crucial for managing late-stage CKD.
Conclusions:
- Incorporating individual kidney disease trajectories enhances clinical management.
- Optimizing timing for interventions like vascular access and transplant referral is possible.
- Personalized care pathways can lead to better outcomes and smoother transitions to ESRD.