Key result
Initiating maintenance dialysis during 2005-2009 versus 2000-2004 was associated with higher odds of starting at an eGFR of 10-15 ml/min per 1.73 m2 (OR 1.43; 95% CI 1.13-1.81) despite similar clinical presentation.
Why the study?
Does the secular trend of increasing eGFR at dialysis initiation reflect changes in clinical presentation over time?
Population
1,691 patients who initiated maintenance dialysis in the Department of Veterans Affairs in fiscal years…
Comparison
Dialysis initiation in fiscal years 2005-2009 vs Dialysis initiation in fiscal years 2000-2004
Design
Cohort
Authors
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Increasing eGFR at dialysis initiation may signal earlier starts; leaves open effects on outcomes and optimal timing.
Observational (n=1,691)
Yes
Does the secular trend of increasing eGFR at dialysis initiation reflect changes in clinical presentation over time?
Odds Ratio: 1.43 (95% CI 1.13–1.81)
Absolute Event Rate: 29.9% vs 23.4%
p-value: p=0.002
The trend of initiating dialysis at higher eGFR levels in the VA system does not appear to be driven by changes in the clinical context or severity of illness at initiation.
O’Hare et al. (2015) conducted an observational in Maintenance dialysis initiation (n=1,691). Later time period (fiscal years 2005-2009) vs. Earlier time period (fiscal years 2000-2004) was evaluated on Initiating dialysis at an eGFR of 10-15 ml/min per 1.73 m2 (versus <10 ml/min per 1.73 m2) (OR 1.43, 95% CI 1.13 to 1.81, p=0.002). Initiating maintenance dialysis during 2005-2009 versus 2000-2004 was associated with higher odds of starting at an eGFR of 10-15 ml/min per 1.73 m2 (OR 1.43; 95% CI 1.13-1.81) despite similar clinical presentation.
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