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• W2022295342 abstract "Today there are approximately 23.5 million individuals in the United States with chronic kidney disease (CKD), as defined by estimated glomerular filtration rate (eGFR) , 60 mL/min/1.73 m or persistent albumin-creatinine ratio . 30 mg/g. It has been demonstrated that CKD is associated with significant sequelae including progression to end-stage renal disease (ESRD), as well as increased cardiovascular morbidity and all-cause mortality. For patients progressing to ESRD, adequate preparation time is required to provide education, consider renal replacement modality options, and plan for the initiation of therapy. The optimal time to begin preparation is uncertain for a number of reasons: estimates of the rate of kidney disease progression based on eGFR slope may be imprecise for individual patients; eGFR decline may be nonlinear and episodes of acute kidney injury or cardiovascular events may unpredictably shorten the time to ESRD. Unforeseen delays also may result from the patient’s initial reluctance to begin renal replacement planning, despite professional advice. Furthermore, when such planning has begun, the time required for ESRD preparation cannot be known a priori: there may be a variable time required to establish a functional arteriovenous access or complete medical preparations in cases in which preemptive transplantation is being considered. Because of these uncertainties, patients with CKD may progress to ESRD without appropriate preparation. Unanticipated progression to ESRD results in missed opportunities for medical optimization or preemptive transplantation and can lead to initiation of dialysis therapy in emergent circumstances. An accurate and precise tool that determines which patients with CKD are likely to progress to ESRD potentially could allow patient-specific discussions regarding prognosis and a more personalized approach to planning renal replacement strategies. System-level benefits also may result from better ESRD risk prediction. Planning for dialysis and transplantation uses a significant amount of resources; unfortunately, preparing for ESRD may be futile for some patients if they die of a competing event prior to reaching ESRD. Thus, appropriately directing resources is important; it can result in timely care plans for many patients, avoid possibly futile or unnecessary interventions in others," @default.
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• W2022295342 date "2015-03-01" @default.
• W2022295342 modified "2023-09-24" @default.
• W2022295342 title "Use of the Kidney Failure Risk Equation to Reduce Uncertainty in Predicting Time to ESRD" @default.
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• W2022295342 doi "https://doi.org/10.1053/j.ajkd.2015.01.002" @default.
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