Twelve-Month Estimated Glomerular Filtration Rate Trajectory at the Time of Kidney Replacement Therapy Counseling...

Background/Objectives: Planned kidney replacement therapy (KRT) proactively selects and prepares appropriate dialysis modalities and ensures timely vascular access-be it arteriovenous or peritoneal-before dialysis is needed. This approach leads to better patient outcomes and fewer complications. We aimed to develop a predictive model using past estimated glomerular filtration rate (eGFR) measurements prior to KRT counseling to estimate individual patients' likelihood of initiating dialysis. Methods: In this prognostic prediction study, we retrospectively analyzed data from chronic kidney disease patients who received KRT counseling at Naresuan University Hospital in Thailand. A logistic regression model was developed incorporating the historical eGFR decline over the preceding twelve months (eGFRr) at the time of counseling. The model's performance was compared to the predictive accuracy of using a single eGFR measurement, as commonly practiced in clinical settings. Results: This study included 103 patients who received their first KRT counseling between 1 January 2016 and 31 December 2022. Within one year, 62% initiated their first dialysis session. The eGFRr was a significant predictor of dialysis initiation. Logistic regression identified six key predictors: past eGFRr, age, systolic blood pressure, primary cause of chronic kidney disease, body mass index categories, and serum calcium levels. The predictive model showed good discriminative ability, with an area under the receiver operating characteristic curve of 0.836 (95% CI 0.754-0.918). Conclusions: Our predictive model estimates the likelihood of dialysis initiation, offering valuable decision support insights. Clinical implementation could enhance timely referral and preparation for patients requiring KRT. Prospective validation is needed to confirm its accuracy before clinical use.