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Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease

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Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease. / Chandna, Shahid M.; Carpenter, Lewis; Da Silva-Gane, Maria; Warwicker, Paul; Greenwood, Roger N.; Farrington, Ken.

In: Nephron, Vol. 134, No. 2, 01.10.2016, p. 64-72.

Research output: Contribution to journalArticle

Harvard

Chandna, SM, Carpenter, L, Da Silva-Gane, M, Warwicker, P, Greenwood, RN & Farrington, K 2016, 'Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease', Nephron, vol. 134, no. 2, pp. 64-72. https://doi.org/10.1159/000447784

APA

Chandna, S. M., Carpenter, L., Da Silva-Gane, M., Warwicker, P., Greenwood, R. N., & Farrington, K. (2016). Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease. Nephron, 134(2), 64-72. https://doi.org/10.1159/000447784

Vancouver

Chandna SM, Carpenter L, Da Silva-Gane M, Warwicker P, Greenwood RN, Farrington K. Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease. Nephron. 2016 Oct 1;134(2):64-72. https://doi.org/10.1159/000447784

Author

Chandna, Shahid M. ; Carpenter, Lewis ; Da Silva-Gane, Maria ; Warwicker, Paul ; Greenwood, Roger N. ; Farrington, Ken. / Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease. In: Nephron. 2016 ; Vol. 134, No. 2. pp. 64-72.

Bibtex Download

@article{eccac764277940c3a78a9702142a0e77,
title = "Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease",
abstract = "Aim: In elderly, dependent patients with advanced chronic kidney disease, dialysis may confer only a small survival advantage over conservative kidney management (CKM). We investigated the role of rate of decline of kidney function on treatment choices and survival. Methods: We identified a retrospective (1995-2010) cohort of patients aged over 75 years, with progressive kidney impairment and an estimated glomerular filtration rate (eGFR) between 10 and 15 ml/min/1.73 m2 . All subsequently chose to be treated by either dialysis or CKM. Patients were followed for a minimum of 3 years. Results: Of 250 patients identified, 92 (37{\%}) opted for dialysis and 158 (63{\%}) for CKM. Mean age was 80.9 ± 4.0 years. eGFR was 13.3 ± 1.4 initially and 8.7 ± 3.0 ml/min/1.73 m 2 at follow-up. Both were similar in those on dialysis and CKM pathways. Rate of decline of eGFR was more rapid in those choosing dialysis (0.45 (interquartile range, IQR 0.64) vs. 0.21 (IQR 0.28) ml/min/1.73 m2/month, p < 0.001), and independently predicted choice of CKM. In pa-Received: February 24, 2016 Accepted after revision: June 21, 2016 Published online: July 16, 2016 tients with high comorbidity, choice of dialysis was associated with a non-significant adjusted survival advantage of 5 months. Inclusion in models of time dependent eGFR during follow-up (eGFRtd )-a reflection of the rate of decline of kidney function-showed it to be independently associated with mortality risk in those on the CKM (p < 0.001) but not on the dialysis pathway. CKM pathway patients at the 25th centile of eGFRtd had an adjusted survival of 7 months compared to 63 months for those at the 75th centile. Conclusions: Rate of decline of kidney function is a determinant of CKM choice in elderly patients and is associated with mortality risk in patients of the CKM pathway. These findings should inform counselling.",
keywords = "Chronic kidney disease, Conservative kidney management, Dialysis, Modality choice, Rate of decline of kidney function, Survival",
author = "Chandna, {Shahid M.} and Lewis Carpenter and {Da Silva-Gane}, Maria and Paul Warwicker and Greenwood, {Roger N.} and Ken Farrington",
year = "2016",
month = "10",
day = "1",
doi = "10.1159/000447784",
language = "English",
volume = "134",
pages = "64--72",
journal = "NEPHRON JOURNALS",
issn = "1660-8151",
publisher = "S. Karger AG",
number = "2",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Rate of Decline of Kidney Function, Modality Choice, and Survival in Elderly Patients with Advanced Kidney Disease

AU - Chandna, Shahid M.

AU - Carpenter, Lewis

AU - Da Silva-Gane, Maria

AU - Warwicker, Paul

AU - Greenwood, Roger N.

AU - Farrington, Ken

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Aim: In elderly, dependent patients with advanced chronic kidney disease, dialysis may confer only a small survival advantage over conservative kidney management (CKM). We investigated the role of rate of decline of kidney function on treatment choices and survival. Methods: We identified a retrospective (1995-2010) cohort of patients aged over 75 years, with progressive kidney impairment and an estimated glomerular filtration rate (eGFR) between 10 and 15 ml/min/1.73 m2 . All subsequently chose to be treated by either dialysis or CKM. Patients were followed for a minimum of 3 years. Results: Of 250 patients identified, 92 (37%) opted for dialysis and 158 (63%) for CKM. Mean age was 80.9 ± 4.0 years. eGFR was 13.3 ± 1.4 initially and 8.7 ± 3.0 ml/min/1.73 m 2 at follow-up. Both were similar in those on dialysis and CKM pathways. Rate of decline of eGFR was more rapid in those choosing dialysis (0.45 (interquartile range, IQR 0.64) vs. 0.21 (IQR 0.28) ml/min/1.73 m2/month, p < 0.001), and independently predicted choice of CKM. In pa-Received: February 24, 2016 Accepted after revision: June 21, 2016 Published online: July 16, 2016 tients with high comorbidity, choice of dialysis was associated with a non-significant adjusted survival advantage of 5 months. Inclusion in models of time dependent eGFR during follow-up (eGFRtd )-a reflection of the rate of decline of kidney function-showed it to be independently associated with mortality risk in those on the CKM (p < 0.001) but not on the dialysis pathway. CKM pathway patients at the 25th centile of eGFRtd had an adjusted survival of 7 months compared to 63 months for those at the 75th centile. Conclusions: Rate of decline of kidney function is a determinant of CKM choice in elderly patients and is associated with mortality risk in patients of the CKM pathway. These findings should inform counselling.

AB - Aim: In elderly, dependent patients with advanced chronic kidney disease, dialysis may confer only a small survival advantage over conservative kidney management (CKM). We investigated the role of rate of decline of kidney function on treatment choices and survival. Methods: We identified a retrospective (1995-2010) cohort of patients aged over 75 years, with progressive kidney impairment and an estimated glomerular filtration rate (eGFR) between 10 and 15 ml/min/1.73 m2 . All subsequently chose to be treated by either dialysis or CKM. Patients were followed for a minimum of 3 years. Results: Of 250 patients identified, 92 (37%) opted for dialysis and 158 (63%) for CKM. Mean age was 80.9 ± 4.0 years. eGFR was 13.3 ± 1.4 initially and 8.7 ± 3.0 ml/min/1.73 m 2 at follow-up. Both were similar in those on dialysis and CKM pathways. Rate of decline of eGFR was more rapid in those choosing dialysis (0.45 (interquartile range, IQR 0.64) vs. 0.21 (IQR 0.28) ml/min/1.73 m2/month, p < 0.001), and independently predicted choice of CKM. In pa-Received: February 24, 2016 Accepted after revision: June 21, 2016 Published online: July 16, 2016 tients with high comorbidity, choice of dialysis was associated with a non-significant adjusted survival advantage of 5 months. Inclusion in models of time dependent eGFR during follow-up (eGFRtd )-a reflection of the rate of decline of kidney function-showed it to be independently associated with mortality risk in those on the CKM (p < 0.001) but not on the dialysis pathway. CKM pathway patients at the 25th centile of eGFRtd had an adjusted survival of 7 months compared to 63 months for those at the 75th centile. Conclusions: Rate of decline of kidney function is a determinant of CKM choice in elderly patients and is associated with mortality risk in patients of the CKM pathway. These findings should inform counselling.

KW - Chronic kidney disease

KW - Conservative kidney management

KW - Dialysis

KW - Modality choice

KW - Rate of decline of kidney function

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=84979055735&partnerID=8YFLogxK

U2 - 10.1159/000447784

DO - 10.1159/000447784

M3 - Article

C2 - 27423919

AN - SCOPUS:84979055735

VL - 134

SP - 64

EP - 72

JO - NEPHRON JOURNALS

JF - NEPHRON JOURNALS

SN - 1660-8151

IS - 2

ER -

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