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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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Starting Renal Replacement Therapy: Is It About Time?

Elaine Ku1,2, Charles E McCulloch3, Kirsten L Johansen4,3

  • 1Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA, elaine.ku@ucsf.edu.

American Journal of Nephrology
|July 4, 2019
PubMed
Summary
This summary is machine-generated.

Patients with chronic kidney disease (CKD) stage 5 spend less time in this stage than predicted, suggesting potential for delaying renal replacement therapy (RRT) in certain individuals.

Keywords:
Chronic kidney diseaseEnd-stage renal diseaseTiming of dialysis initiation

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Area of Science:

  • Nephrology
  • Renal Medicine
  • Clinical Epidemiology

Background:

  • Studies on end-stage renal disease (ESRD) timing often use estimated glomerular filtration rate (eGFR) criteria.
  • Current definitions of early vs. late dialysis initiation lack a time-based perspective.

Purpose of the Study:

  • To compare the theoretical time in chronic kidney disease (CKD) stage 5 with the actual time spent.
  • To identify patient subgroups who might benefit from delayed renal replacement therapy (RRT).

Main Methods:

  • Retrospective study of 870 participants with CKD stage 5 from the Chronic Renal Insufficiency Cohort.
  • Used mixed models to estimate individual renal function trajectories.
  • Compared predicted time in CKD stage 5 (eGFR 15 to 5 mL/min/1.73 m2) with actual time to RRT.

Main Results:

  • Median observed time from eGFR 15 to RRT was 9.6 months; median predicted time from eGFR 15 to 5 was 17.7 months.
  • Significant differences observed in patients with systolic blood pressure <140 mm Hg, proteinuria <1 g/g, and serum albumin ≥3.5 g/dL.
  • These subgroups had longer predicted than actual time in CKD stage 5.

Conclusions:

  • Marked discrepancies exist between actual and predicted time spent in CKD stage 5.
  • Timing of dialysis initiation needs a time-based perspective.
  • Identifying subgroups who may benefit from delayed RRT is crucial.