Association of glomerular filtration rate slope with timely creation of vascular access in incident hemodialysis

Abstract

The factors associated with the timely creation of distal vascular access for hemodialysis initiation are unclear. We aimed to explore the association between the slope of estimated glomerular filtration rate (eGFR) and the successful usage of vascular access upon hemodialysis initiation. This single center retrospective cohort study enrolled chronic kidney disease patients who undertook a multidisciplinary care program from 2003 to 2016. Using eGFR slope as predictor, we evaluated the vascular access created timely upon hemodialysis initiation. Among the 987 patients, vascular access was created at a median eGFR of 5.8 min/ml/1.73 m2, with a median duration of 3.1 months before hemodialysis. The proportions of vascular access created timely, created not timely (vascular access immature), and not created were 68.5%, 8.8%, and 22.7%, respectively. There was a significant negative association of eGFR upon vascular access creation with eGFR slope (r = − 0.182, P < 0.001). The fastest eGFR slope patients (the first quartile or < − 10 min/ml/1.73 m2/year) had the lowest percentage of vascular access created timely. In the multivariable logistic regression analysis, only higher eGFR upon vascular access creation (P = 0.001) and eGFR slope (P = 0.009) were significantly associated with vascular access created timely. The adjusted odds ratios of each quartile of eGFR slopes for vascular access created timely were 0.46 (95% confidence interval 0.27–0.86), 1.30 (0.62, 2.72), 1.00 (reference), and 0.95 (0.48–1.87), respectively. eGFR slope is associated with the timely creation of vascular access for the initiation of hemodialysis in a reverse-J-shaped pattern and may help determine the time of vascular access creation.

[Retracted] Analysis of Nursing Effect of Comprehensive Nursing Intervention on Hemodialysis Patients with Uremia

“…Few studies have explicitly tested conformity and published the conformity rate [ 17 ]; however, the interdialytic weight gain (IDWG) and serum phosphorus level are the most often reported indicators for complete conformance. Conformity requirements have been published by the WHO [ 18 ].…”

Predictors of post-kidney transplantation complications among Egyptian recipients—1-year follow-up

“…In our study, the mean duration of dialysis before transplantation was 18.1 ± 21.88 months that goes in the same line with a study which assessed the relation of duration of dialysis before transplantation with graft and patient survival. The rates of short-term complications such as delayed graft function, acute graft rejection, and acute patient death were significantly higher in patients with ≥ 10-year dialysis than in patients with lesser duration [2,3,10,11].…”

“…Timely referral for transplantation is essential to maximize benefit and should begin when patients estimated Abdelaziz et al The Egyptian Journal of Internal Medicine (2024) 36:68 glomerular filtration rate drops to less than 20 mL/ min/m [3].…”

CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan

“… 12 , 13 , 14 , 15 Similar to these individual-level observations, our findings reflect that the universal CKD care programs could decline the long-term trend of dialysis incidence. Although the fundamental mechanisms of the results are yet to be clarified, recent evidence suggests that more appropriate medication prescriptions, 5 , 16 education and dietary interventions, 17 , 18 complication management, 19 dialysis preparation, 20 as well as their interactions may play essential roles in prolonging kidney disease progression and dialysis initiation. In addition, our results, together with previous reports, 5 , 12 , 21 suggested that the care programs could significantly reduce cardiovascular disease or infectious disease-related mortality, particularly in the first year of dialysis, through improving the electrolyte imbalance correction and arteriovenous fistula preparation.…”