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Different kidney function trajectory patterns before dialysis in elderly patients: clinical implications and

Josefina Santos1,2, Pedro Oliveira3,4, Milton Severo3

  • 1Nephrology Department, Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal.

Renal Failure
|June 30, 2021
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Summary

Identifying distinct kidney function decline patterns in elderly chronic kidney disease (CKD) patients before dialysis is crucial. Rapid decline is linked to higher mortality risk post-dialysis, highlighting the need for tailored pre-dialysis care.

Keywords:
CKDESKDoutcomesrenal function trajectory

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Area of Science:

  • Nephrology
  • Geriatrics
  • Public Health

Background:

  • Chronic kidney disease (CKD) progression varies significantly among patients.
  • Understanding renal function decline trajectories is key for optimizing patient care.
  • Identifying patterns of decline can inform interventions and improve outcomes.

Purpose of the Study:

  • To identify and characterize distinct trajectories of estimated glomerular filtration rate (eGFR) decline in elderly CKD patients before dialysis initiation.
  • To investigate the association between these eGFR trajectories and mortality risk after starting dialysis.

Main Methods:

  • Retrospective cohort study of 378 elderly CKD patients initiating dialysis (2009-2016).
  • Utilized mixed-effects models (linear, quadratic, cubic) and probabilistic clustering to define eGFR trajectories.
  • Employed multivariable multinomial logistic regression and Cox models to analyze patient characteristics, care practices, and mortality associations.

Main Results:

  • Four distinct eGFR decline trajectories were identified: slower (18.3%), gradual (18.3%), early rapid (41.2%), and rapid (22.2%).
  • Patients with rapid eGFR decline exhibited higher rates of diabetes, cognitive impairment, and pre-dialysis hospitalization, with less pre-dialysis care.
  • Rapid decline trajectories were associated with increased mortality risk within the first and fourth year post-dialysis initiation and beyond 4 years on dialysis.

Conclusions:

  • Distinct patterns of eGFR decline exist in elderly CKD patients prior to dialysis.
  • These trajectories can identify individuals at higher risk of accelerated kidney function loss.
  • Understanding these patterns is vital for refining pre-end-stage kidney disease (ESKD) care and mitigating post-dialysis mortality risk.