EurekaMag.com logo
+ Site Statistics
References:
53,869,633
Abstracts:
29,686,251
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Trends in the Timing and Clinical Context of Maintenance Dialysis Initiation



Trends in the Timing and Clinical Context of Maintenance Dialysis Initiation



Journal of the American Society of Nephrology 26(8): 1975-1981



Whether secular trends in eGFR at dialysis initiation reflect changes in clinical presentation over time is unknown. We reviewed the medical records of a random sample of patients who initiated maintenance dialysis in the Department of Veterans Affairs (VA) in fiscal years 2000-2009 (n=1691) to characterize trends in clinical presentation in relation to eGFR at initiation. Between fiscal years 2000-2004 and 2005-2009, mean eGFR at initiation increased from 9.8±5.8 to 11.0±5.5 ml/min per 1.73 m(2) (P<0.001), the percentage of patients with an eGFR of 10-15 ml/min per 1.73 m(2) increased from 23.4% to 29.9% (P=0.002), and the percentage of patients with an eGFR>15 ml/min per 1.73 m(2) increased from 12.1% to 16.3% (P=0.01). The proportion of patients who were acutely ill at the time of initiation and the proportion of patients for whom the decision to initiate dialysis was based only on level of kidney function did not change over time. Frequencies of documented clinical signs and/or symptoms were similar during both time periods. The adjusted odds of initiating dialysis at an eGFR of 10-15 or >15 ml/min per 1.73 m(2) (versus <10 ml/min per 1.73 m(2)) during the later versus earlier time period were 1.43 (95% confidence interval [95% CI], 1.13 to 1.81) and 1.46 (95% CI, 1.09 to 1.97), respectively. In conclusion, trends in eGFR at dialysis initiation at VA medical centers do not seem to reflect changes in the clinical context in which dialysis is initiated.

(PDF emailed within 0-6 h: $19.90)

Accession: 059172315

Download citation: RISBibTeXText

PMID: 25700539

DOI: 10.1681/ASN.2013050531



Related references

Trends in timing of initiation of chronic dialysis in the United States. Archives of Internal Medicine 171(18): 1663-1669, 2011

Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs. Clinical Journal of the American Society of Nephrology 10(8): 1418-1427, 2016

Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial. Peritoneal Dialysis International 32(6): 595-604, 2013

Ideal timing and predialysis nephrology care duration for dialysis initiation: from analysis of Japanese dialysis initiation survey. Therapeutic Apheresis and Dialysis 16(1): 54-62, 2012

Timing of Initiation of Maintenance Dialysis: A Qualitative Analysis of the Electronic Medical Records of a National Cohort of Patients From the Department of Veterans Affairs. JAMA Internal Medicine 176(2): 228-235, 2016

The Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis: a paradigm shift and the return of the clinical nephrologist. Giornale Italiano di Nefrologia 31(3): -, 2016

Trends in initiation of dialysis in an urban dialysis clinic in the United States: a long way from dialysis outcomes quality initiative guidelines. Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis 15: 138-143, 2000

Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. Cmaj 186(2): 112-117, 2014

Effect of dialysis initiation timing on clinical outcomes: a propensity-matched analysis of a prospective cohort study in Korea. Plos One 9(8): E105532-E105532, 2015

An assessment of dialysis provider's attitudes towards timing of dialysis initiation in Canada. Canadian Journal of Kidney Health and Disease 1(): 3-3, 2014

Early dialysis initiation and rates and timing of withdrawal from dialysis in Canada. Clinical Journal of the American Society of Nephrology 8(2): 265-270, 2013

The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis. Peritoneal Dialysis International 35(7): 703-711, 2016

Timing of dialysis initiation Diagnostic accuracy of estimates of renal function in pre-dialysis patients. Journal of the American Society of Nephrology 12(Program and Abstract Issue): 334A, September, 2001

Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline. American Journal of Kidney Diseases 66(5): 823-836, 2016

Initiation of dialysis: current trends and the case for timely initiation. Peritoneal Dialysis International 20 Suppl 2: S142-S149, 2000