Third-year trajectories of reduction in estimated gfr before start of dialysis according to the data of the city register of patients with CKD


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Abstract

Several studies describe the trajectories of reduction in glomerular filtration rate (GFR) before starting dialysis. The trajectories of reduction in GFR may affect the conditions for starting dialysis and long-term prognosis. Material and methods. Among 1029 unselected patients who started dialysis in St. Petersburg in 2012-2014, 481 (46.7%) were observed for a long time in the City nephrology Center, and included in the City Register of patients with CKD. The mean age was 63±12 years, 47.4% women, 21.8% diabetic patients. The median of the number of visits with an assessment of the estimated (e)GFR was 7 (interquartile range - IR 5÷9); the duration of follow-up for 352 (73.1%) patients exceeded 36 months, for the remaining 129 (26.9%) patients was 21 (14÷28) month. Results. The initial eGFR was 43±22 ml/min/1.73 m2; median proteinuria - 1.4 g/day (0.5÷3.1). The mean rate of decrease in eGFR in the whole group was -3.94 ml/min/1.73 m2 per year (95% confidence interval [Сі] -6.48÷-1.87). We identified three types of trajectory of the decrease in eGFR: slow progression (-2.58, 95% CI - -4.95÷-0.67 ml/min/1.73 m2 per year) from cKD-3B-cKD-4 - 73% of patients, fast progression (-7.81, 95% CI - -10.32÷-5.71) from CKD-З -22% of patients, accelerated progression - initial absence of progression ( + 0.31, 95% CI - -1.61÷-2.16), followed by an acceleration in the reduction of eGFR (-21.3, 95% CI --32.4÷11.7) from CKD-3-5% of patients. Dialysis was started at eGFR 7±3 ml/min/1.73 m2 in the "slow" group (32% started dialysis urgently), 6±4 - in "fast" group (52% - urgently), and 5±4 ml/min/1.73 m2 - in the group of "accelerated" progression (58% - urgently). In addition to differences in eGFR at the start of dialysis, patients differed in the anemia, hyperphosphataemia and blood pressure levels; differences between groups in the structure of diagnoses did not reach statistical significance. Conclusion. CKD progression before dialysis happens in different ways, which can affect the conditions for starting dialysis and planning the management of a patient with CKD.

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