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Relationship between mortality and speed of eGFR decline in the 3 months prior to dialysis initiation

Clinical and Experimental Nephrology volume 21, pages 159–168 (2017)Cite this article

Abstract

Background

The timing for initiating dialysis in chronic kidney disease is often determined by the clinical symptoms and estimated glomerular filtration rate (eGFR). However, very few studies have examined how the speed of kidney function decline before initiating dialysis relates to mortality after dialysis initiation. Here, we report our examination of the relationship between the speed of eGFR decline in the 3 months prior to dialysis initiation and mortality.

Methods

The study included 1292 new dialysis patients who were registered in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. The subjects were placed in 4 groups based on the speed of eGFR decline in the 3 months before initiating dialysis (eGFR at 3 months before initiation—eGFR at initiation) <2: ≥2, <4: ≥4, <6: ≥6 mL/min/1.73 m2. All-cause, cardiovascular, and infection-related mortality rates were compared using Kaplan–Meier curves. A multivariate analysis using the Cox proportional hazard model was used to extract the factors that contributed to all-cause mortality.

Results

The group with faster eGFR decline exhibited significantly more heart failure symptoms when dialysis was initiated. Rapid eGFR decline correlated with prognosis (log-rank test: all-cause mortality p < 0.001, cardiovascular mortality p < 0.001). The speed of eGFR decline was related to elevated all-cause mortality rates [eGFR decline 10 mL/min/1.73 m2, HR (95 % CI) = 1.53 (1.12–2.08)].

Conclusions

This study showed that patients with rapid eGFR decline in the 3 months before initiating dialysis more often presented with heart failure symptoms when dialysis was initiated and had poorer survival prognoses.

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Acknowledgments

We acknowledge the support provided by the following investigators and members of the Aichi Cohort study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP), who participated in this study: Yasuhiro Otsuka, Asami Takeda (Japanese Red Cross Nagoya Daiichi Hospital), Hirofumi Tamai (Anjo Kosei Hospital), Tomohiko Naruse (Kasugai Municipal Hospital), Kei Kurata (Tosei General Hospital), Hideto Oishi (Komaki City Hospital), Isao Aoyama (Japanese Community Healthcare Organization Chukyo Hospital), Hiroshi Ogawa (Shinseikai Daiichi Hospital), Hiroko Kushimoto(Chita City Hospital), Hideaki Shimizu (Chubu-Rosai Hospital), Junichiro Yamamoto(Tsushima City Hospital), Hisashi Kurata (Toyota Kosei Hospital), Taishi Yamakawa (Toyohashi Municipal Hospital), TakaakiYaomura (Nagoya Medical Center), Hirotake Kasuga(Nagoya Kyouritsu Hospital), Shizunori Ichida (Japanese Red Cross Nagoya Daiichi Hospital), Shoichi Maruyama (Nagoya University Graduate School of Medicine), Seiichi Matsuo (Nagoya University Graduate School of Medicine), Noritoshi Kato (Nagoya University Graduate Schoolof Medicine), Shigehisa Koide (Fujita Health University Hospital), and Yukio Yuzawa (Fujita Health University Hospital).

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Affiliations

  1. Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan

    Daijo Inaguma, Minako Murata, Akihito Tanaka & Hibiki Shinjo

Authors
  1. Daijo Inaguma
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  2. Minako Murata
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  3. Akihito Tanaka
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  4. Hibiki Shinjo
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Corresponding author

Correspondence to Daijo Inaguma.

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Competing interests

The Aichi Kidney Foundation funded this study. The authors declare no competing interests.

Additional information

D. Inaguma was an investigator and member of Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP).

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Cite this article

Inaguma, D., Murata, M., Tanaka, A. et al. Relationship between mortality and speed of eGFR decline in the 3 months prior to dialysis initiation. Clin Exp Nephrol 21, 159–168 (2017). https://doi.org/10.1007/s10157-016-1262-z

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  • DOI: https://doi.org/10.1007/s10157-016-1262-z

Keywords

  • Chronic kidney disease
  • Dialysis initiation
  • GFR decline
  • Mortality