Trajectories of Kidney Function Decline in the 2 Years Before Initiation of Long-term Dialysis

O’Hare, Ann M.; Batten, Adam; Burrows, Nilka Ríos; Pavkov, Meda E.; Taylor, Larry E.; Gupta, Indra R.; Todd-Stenberg, Jeff; Maynard, Charles; Rodriguez, Rudolph A.; Murtagh, Fliss E.M.; Larson, Eric B.; Williams, Desmond E.

doi:10.1053/j.ajkd.2011.11.044

Cited by 208 publications

(211 citation statements)

References 25 publications

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“…The second case report presented above demonstrated the syndrome of rapid onset ESRD, or SORO-ESRD, that is to say, acute yet irreversible renal failure requiring permanent RRT including kidney transplantation where applicable (7)(8)(9)(10). Several other large studies of the trajectories of renal failure to ESRD have confirmed our observations (18)(19)(20). In the more recent nephrology literature, 2011-2012, we have further identified three corroborating new reports that have further substantiated our recent descriptions of the phenomenon of SORO-ESRD (18)(19)(20).…”

Section: Discussionsupporting

confidence: 89%

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

Onuigbo¹,

Samuel²,

Agbasi³

2018

J Renal Inj Prev

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In 2005, we had described for the first time, the syndrome of late onset renal failure from angiotensin blockade (LORFFAB), represented by the observed accelerated loss of kidney function in patients on a priori stable doses of an angiotensin converting enzyme inhibitor and/or an angiotensin receptor blocker, for more than three months, with this acute kidney injury (AKI) occurring despite the absence of any identifiable known precipitating factors. Moreover, in 2010, we had described the syndrome of rapid onset end-stage renal disease (SORO-ESRD), represented by acute yet irreversible renal failure following medical illness or surgical procedures, again sometimes in association with concurrent angiotensin blockade. In this article, we describe two representative case reports, one each of both syndromes, and discuss the implications of LORFFAB and SORO-ESRD in current nephrology practice paradigms.Please cite this paper as: Onuigbo M, Samuel E, Agbasi N. Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset end-stage renal disease (SORO-ESRD) revisited -Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper. J Renal Inj Prev. 2018;7(2):58-63. DOI: 10.15171/jrip.2018.15. In 2005, we described for the first time, the syndrome of late onset renal failure from angiotensin blockade (LORFFAB). This is accelerated loss of kidney function in patients on a priori stable doses of an angiotensin converting enzyme inhibitor and/or an angiotensin receptor blocker (ARB), for more than 3 months, with this acute kidney injury (AKI) occurring in the absence of any identifiable known precipitating factors. Moreover, in 2010, we described the syndrome of rapid onset end-stage renal disease (SORO-ESRD). This is acute yet irreversible renal failure following medical illness or surgical procedures, again sometimes in association with concurrent angiotensin blockade. In this article, we describe two representative case reports, one case for LORFFAB and another case for SORO-ESRD and subsequently discuss the implications of LORFFAB and SORO-ESRD in current nephrology practice paradigms. Whereas we support the consensus that angiotensin blockade, for now, remains the mainstay of renoprotection, we however must draw attention to the potential for nephrotoxicity from angiotensin blockade under certain clinical scenarios including the ones described here and more. The association of LORFFAB and SORO-ESRD demands further investigation.

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Section: Discussionsupporting

confidence: 89%

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

Onuigbo¹,

Samuel²,

Agbasi³

2018

J Renal Inj Prev

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“…9 Uncertainty about disease trajectory and prognosis can hamper formulation of future plans and treatment preferences. [10][11][12] Prior studies have evaluated the association of patient characteristics (e.g., comorbid conditions and functional status) 5,13,14 and treatment practices (e.g., early nephrology referral and type of vascular access) 15,16 before and at the time of dialysis initiation with subsequent outcomes. However, many of these analyses did not capture information on clinical circumstances around the time of dialysis initiation.…”

mentioning

confidence: 99%

“…In reality, chronic dialysis is often initiated in the context of acute illness 17,18 and rapid or unexpected loss of renal function. 14 We hypothesized that illness severity around the time of dialysis initiation-as reflected in measures of health care intensity, such as length of hospitalization and use of intensive procedures-might provide information useful for anticipatory guidance and supporting treatment decisions in older adults newly initiated on chronic dialysis. To evaluate this hypothesis, we used data from the U.S. Renal Data System (USRDS), a national registry of ESRD, to identify 416,657 Medicare beneficiaries aged $67 years and describe the intensity of care they experienced around the time of initiation of chronic dialysis and its association with survival and patterns of future healthcare utilization.…”

mentioning

confidence: 99%

Healthcare Intensity at Initiation of Chronic Dialysis among Older Adults

Wong¹,

Kreuter

O’Hare

2014

Journal of the American Society of Nephrology

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Little is known about the circumstances under which older adults initiate chronic dialysis and subsequent outcomes. Using national registry data, we conducted a retrospective analysis of 416,657 Medicare beneficiaries aged $67 years who initiated chronic dialysis between January 1995 and December 2008. Our goal was to define the relationship between health care intensity around the time of dialysis initiation and subsequent survival and patterns of hospitalization, use of intensive procedures (mechanical ventilation, feeding tube placement, and cardiopulmonary resuscitation), and discontinuation of dialysis before death. We found that most patients (64.5%) initiated dialysis in the hospital, including 36.6% who were hospitalized for $2 weeks and 7.4% who underwent one or more intensive procedures. Compared with patients who initiated dialysis in the outpatient setting, those who received the highest intensity of care at dialysis initiation (those hospitalized $2 weeks and receiving at least one intensive procedure) had a shorter median survival (0.7 versus 2.1 years; P,0.001), spent a greater percentage of remaining followup time in the hospital (median, 22.9% versus 3.1%; P,0.001), were more likely to undergo subsequent intensive procedures (44.9% versus 26.0%; adjusted hazard ratio, 2.33; 95% confidence interval [CI], 2.27 to 2.39), and were less likely to have discontinued dialysis before death (19.1% versus 26.2%; adjusted odds ratio, 0.68; 95% CI, 0.65 to 0.72). In conclusion, most older adults initiate chronic dialysis in the hospital. Those who have a prolonged hospital stay and receive other forms of life support around the time of dialysis initiation have limited survival and more intensive patterns of subsequent healthcare utilization.

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“…Few studies have determined the pre-AKI slope, and most instead adjust for the static pre-AKI GFR (see number 1 in Figure 1). One study that identified four different trajectories of kidney function decline before ESRD showed that AKI was more common in those with fast progression to ESRD, yet precipitants such as "hematologic malignancy," "other," and "unknown" were also much more common in fast progressors (22).…”

mentioning

confidence: 99%

Is it AKI or Nonrecovery of Renal Function That Is Important for Long-Term Outcomes?

Coca

2013

Clinical Journal of the American Society of Nephrology

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Epidemiologic research examines relationships between exposures and outcomes, with the ultimate goal of improving patient outcomes. To affect a change and improve outcomes, the relationships described must not only be causal, but modifiable (1). Numerous studies have described independent associations between AKI and subsequent CKD and mortality (2). The majority of these studies focused on one dimension of AKI, "severity," via the magnitude of peak rise in serum creatinine (2-4). Recently, some investigations have examined long-term outcomes associated with other dimensions of AKI including duration (5) and kidney function after peak (i.e., recovery) (6-8).Pannu and colleagues performed a retrospective analysis of 190,962 Albertans to assess the modifying effect of renal recovery on the relationship between AKI and long-term outcomes (9). They found that participants who did not recover to within 25% of baseline GFR within 90 days of AKI were at higher risk for doubling of creatinine and ESRD, and for all-cause mortality. It is a well done study with several strengths. First, this is a large population-based study with appropriate inclusion/exclusion criteria, which limited selection bias. Participants were required to have serum creatinine measurement within 180 days before, $1 measurement during, and at least one measurement after hospitalization; only those who survived at least 90 days post-AKI were included in the analyses. Second, the AKI definition used for the primary exposure was appropriate (Kidney Disease Improving Global Outcomes stage 2). Third, the recovery definition was valid and sound (post-AKI creatinine value within 25% of baseline within 90 days, and sensitivity analyses performed using 10% increments to find the threshold for the association between recovery and outcomes). Finally, the dataset provided sufficient outcomes for robust analyses and multivariable adjustment, and there was adequate length of follow-up (median 3 years).Unlike other studies that have examined the association between reversible AKI and long-term outcomes (6,7), Pannu and colleagues treated reversible AKI (instead of the non-AKI group) as the referent group for their analyses. In the follow-up period, 27% of those who did not experience AKI recovery developed doubling of serum creatinine/ESRD compared with 7.5% in those that recovered (adjusted hazard ratio of approximately 4). These data certainly quantify the public health effect of irreversible AKI in a broad, nonselected population. Because nonrecovery from AKI results in a substantial healthcare burden, these data can help clinicians make plans for follow-up with patients, their primary care providers, and nephrologists after discharge (10).The authors did not make any claims about causality in their paper. Looking forward, however, it is important to determine whether we can affect and improve these outcomes. Reiterating the above, the relationship between the exposure and outcome must be causal in order to modify risk. Are the relationships between AKI and lo...

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Trajectories of Kidney Function Decline in the 2 Years Before Initiation of Long-term Dialysis

Cited by 208 publications

References 25 publications

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

Healthcare Intensity at Initiation of Chronic Dialysis among Older Adults

Is it AKI or Nonrecovery of Renal Function That Is Important for Long-Term Outcomes?

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