BACKGROUND AND OBJECTIVES: The optimal timing of dialysis initiation is still unclear. We aimed to ascertain whether a strict clinical follow-up can postpone need for dialysis in chronic kidney disease (CKD) stage 5 patients. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We reviewed records of all consecutive adult patients attending our conservative CKD stage 5 outpatient clinic from 2001 to 2010. Chronicity was defined as two consecutive estimated glomerular filtration rate (eGFR) measurements below 15 ml/min/1.73 m(2). Characteristics of subjects, including comorbidities, were assessed at baseline; blood pressure and serum markers of uremia were assessed both at first and last visit. GFR was estimated by the 4-variable Modification of Diet in Renal Disease (MDRD) formula. RESULTS: In the 312 patients analyzed baseline eGFR was 9.7 ± 2.7 ml/min, which declined by 1.93 ± 4.56 ml/min after 15.6 ± 18.2 months. Age was inversely related to eGFR decline (r -0.27, p = 0.000). During conservative follow-up 55 subjects (18%) died. In comparison with those eventually entering dialysis, deceased subjects were older and had a longer follow-up with no CKD progression. Multivariate analysis identified age, proteinuria and lower baseline K values as the only independent determinants of death. One hundred ninety-four subjects (66%) started dialysis with an average eGFR of 6.1 ± 1.9 ml/min. During 35.8 ± 24.7 months of dialysis follow-up, 84 patients died. Multivariate analysis identified age as the main determinant of death (hazard ratio [HR] for every year 1.07, 95% confidence interval [CI] 1.04-1.11, p 0.000). Patients starting dialysis with eGFR below the median, e.g. <5.7 ml/min, showed a better survival (HR for mortality 0.52, 95% CI 0.30-0.89, p 0.016) than the other group. CONCLUSIONS: A well-organized nephrological outpatient clinic for conservative follow-up of CKD stage five patients can delay dialysis entry as long as 1 year. Starting dialysis with eGFR lower than 6 ml/min does not confer any increased risk of death in selected early-referral patients.
BACKGROUND AND OBJECTIVES: The optimal timing of dialysis initiation is still unclear. We aimed to ascertain whether a strict clinical follow-up can postpone need for dialysis in chronic kidney disease (CKD) stage 5 patients. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We reviewed records of all consecutive adult patients attending our conservative CKD stage 5 outpatient clinic from 2001 to 2010. Chronicity was defined as two consecutive estimated glomerular filtration rate (eGFR) measurements below 15 ml/min/1.73 m(2). Characteristics of subjects, including comorbidities, were assessed at baseline; blood pressure and serum markers of uremia were assessed both at first and last visit. GFR was estimated by the 4-variable Modification of Diet in Renal Disease (MDRD) formula. RESULTS: In the 312 patients analyzed baseline eGFR was 9.7 ± 2.7 ml/min, which declined by 1.93 ± 4.56 ml/min after 15.6 ± 18.2 months. Age was inversely related to eGFR decline (r -0.27, p = 0.000). During conservative follow-up 55 subjects (18%) died. In comparison with those eventually entering dialysis, deceased subjects were older and had a longer follow-up with no CKD progression. Multivariate analysis identified age, proteinuria and lower baseline K values as the only independent determinants of death. One hundred ninety-four subjects (66%) started dialysis with an average eGFR of 6.1 ± 1.9 ml/min. During 35.8 ± 24.7 months of dialysis follow-up, 84 patients died. Multivariate analysis identified age as the main determinant of death (hazard ratio [HR] for every year 1.07, 95% confidence interval [CI] 1.04-1.11, p 0.000). Patients starting dialysis with eGFR below the median, e.g. <5.7 ml/min, showed a better survival (HR for mortality 0.52, 95% CI 0.30-0.89, p 0.016) than the other group. CONCLUSIONS: A well-organized nephrological outpatient clinic for conservative follow-up of CKD stage five patients can delay dialysis entry as long as 1 year. Starting dialysis with eGFR lower than 6 ml/min does not confer any increased risk of death in selected early-referral patients.
Authors: Francesco Pizzarelli; Fulvio Lauretani; Stefania Bandinelli; Gwen B Windham; Anna Maria Corsi; Sandra V Giannelli; Luigi Ferrucci; Jack M Guralnik Journal: Nephrol Dial Transplant Date: 2008-11-06 Impact factor: 5.992
Authors: Waqar H Kazmi; David T Gilbertson; Gregorio T Obrador; Haifeng Guo; Brian J G Pereira; Allan J Collins; Annamaria T Kausz Journal: Am J Kidney Dis Date: 2005-11 Impact factor: 8.860
Authors: Jamie P Traynor; Keith Simpson; Colin C Geddes; Christopher J Deighan; Jonathan G Fox Journal: J Am Soc Nephrol Date: 2002-08 Impact factor: 10.121
Authors: Moniek W M van de Luijtgaarden; Marlies Noordzij; Charles Tomson; Cécile Couchoud; Giovanni Cancarini; David Ansell; Willem-Jan W Bos; Friedo W Dekker; Jose L Gorriz; Christos Iatrou; Liliana Garneata; Christoph Wanner; Svjetlana Cala; Olivera Stojceva-Taneva; Patrik Finne; Vianda S Stel; Wim van Biesen; Kitty J Jager Journal: Am J Kidney Dis Date: 2012-08-23 Impact factor: 8.860
Authors: Shahid M Chandna; Maria Da Silva-Gane; Catherine Marshall; Paul Warwicker; Roger N Greenwood; Ken Farrington Journal: Nephrol Dial Transplant Date: 2010-11-22 Impact factor: 5.992
Authors: Mario Pacilio; Roberto Minutolo; Carlo Garofalo; Maria Elena Liberti; Giuseppe Conte; Luca De Nicola Journal: J Nephrol Date: 2015-11-19 Impact factor: 3.902