The following is a summary of “Associations between abrupt transition, dialysis-requiring AKI, and early mortality in ESKD among U.S. veterans,” published in the November 2023 issue of Nephrology by Hsu et al.

Patients with ESKD have a high mortality rate in the first few months after starting dialysis, and their pre-ESRD kidney function trajectory is a predictor of early death.

Researchers explored the association between pre-dialysis kidney function patterns, including abrupt transition and dialysis-requiring AKI (AKI-D), and early mortality after dialysis initiation.

They gathered national data from the U.S. Veterans Health Administration cross-linked with the United States Renal Data System (USRDS). The abrupt transition was defined as having a mean outpatient eGFR ≥ 30 ml/min/1.73m² within 1 year before ESKD. AKI-D was diagnosed with inpatient serum creatinine measurements (a 50% increase from baseline) and billing codes for inpatient AKI dialysis within 30 days before ESKD. The link between pre-ESKD kidney function patterns and all-cause mortality within 90 days post-ESKD was studied using multivariable models.

The results showed 22,815 patients in the final analytic cohort of Veterans initiating hemodialysis and entering the USRDS. Five patterns of kidney function decline were defined. The reference group comprised most patients (68%, N = 15,484) who did not experience an abrupt transition or AKI-D before ESKD. Other groups exhibited abrupt transitions, AKI-D, or both. Patients with abrupt transition, with (N = 503) or without (N = 3,611) AKI-D, had the highest risk of early mortality after ESKD onset, even after adjusting for demographics and comorbidities (adjusted HR 2.10, 95% CI 1.66–2.65 for abrupt transition with AKI-D; adjusted HR 2.10, 95% CI 1.90–2.33 for abrupt transition without AKI-D). Patients with AKI-D but without an abrupt transition pattern (N = 2,141) had only a modestly higher risk of early death (adjusted HR 1.19, 95% CI 1.01–1.40).

They concluded that Abrupt kidney function decline before ESKD was common and associated with higher early mortality in Veterans on hemodialysis.

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-023-03387-9