PHILADELPHIA—Researchers have found substantial heterogeneity in trajectories of renal function during the two-year period leading up to initiation of chronic dialysis, according to a report presented at Kidney Week 2011.

Most patients (63%) had persistently low levels of estimated glomerular filtration rate (eGFR), declining from levels that already were severely reduced two years prior to dialysis initiation (group 1). Another 25% of patients had progressive loss of eGFR, declining from moderately reduced levels two years prior to initiation (group 2). Nine percent had an accelerated loss of eGFR from normal levels two years before initiation (group 3). Three percent had catastrophic loss of eGFR from normal levels six months or less before initiation (group 4).

The study, led by Ann M. O’Hare, MD, Associate Professor of Medicine at the University of Washington in Seattle, and supported by an inter-agency agreement between the VA Puget Sound Healthcare System and the Centers for Disease Control and Prevention, revealed that more rapid loss of eGFR was associated with an increased likelihood of hospitalization and inpatient acute kidney injury (AKI), and a lower likelihood of receiving outpatient nephrology care and vascular access placement during the two years before dialysis initiation. Those with more rapid loss of eGFR were more likely to initiate dialysis in the hospital at a higher level of eGFR and in the setting of AKI, the investigators found.

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Dr. O’Hare’s group also observed a correlation between renal function trajectory and survival. Median survival ranged from 3.2 years for patients in group 1 to 1.0 year for patients in group 4.