Table 4.
Adjusted association of patient characteristics and care practices with eGFR trajectory group
| Patient characteristics | Trajectory group | P for trend | ||
|---|---|---|---|---|
| Progressive eGFR loss (Group 2, n=1,379) | Accelerated eGFR loss (Group 3, n=535) | Catastrophic eGFR loss (Group 4, n=172) | ||
| Age ≥ 75 years | 0.75 (0.64–0.88) | 0.48 (0.38–0.62) | 0.30 (0.19–0.47) | <0.001 |
| White race vs. black or other | 0.93 (0.81–1.10) | 0.86 (0.70–1.11) | 0.96 (0.67–1.37) | 0.2 |
| Female | 0.83 (0.49–1.38) | 0.62 (0.27–1.40) | 0.20 (0.03–1.56) | 0.06 |
| Diabetes | 1.29 (1.10–1.52) | 1.04 (0.81–1.32) | 0.56 (0.36–0.88) | 0.9 |
| Ischemic heart disease | 1.02 (0.88–1.18) | 0.91 (0.72–1.13) | 0.88 (0.60–1.30) | 0.4 |
| Heart failure | 1.52 (1.31–1.76) | 1.53 (1.22–1.92) | 1.25 (0.84–1.86) | <0.001 |
| Stroke | 1.13 (0.93–1.37) | 0.92 (0.67–1.27) | 0.57 (0.29–1.12) | 0.5 |
| Peripheral vascular disease | 1.19 (0.99–1.42) | 1.16 (0.88–1.53) | 0.99 (0.59–1.67) | 0.2 |
| Pulmonary disease | 1.23 (1.00–1.52) | 1.35 (0.99–1.84) | 1.41 (0.38–2.38) | 0.01 |
| Cancer | 1.10 (0.85–1.64) | 1.18 (0.85–1.64) | 1.25 (0.75–2.08) | 0.2 |
| Unable to ambulate or transfer | 1.51 (1.13–2.01) | 2.27 (1.56–3.32) | 2.17 (1.14–4.11) | <0.001 |
| Diabetes or hypertension as a cause of ESRD | 0.79 (0.67–0.94) | 0.37 (0.30–0.46) | 0.16 (0.11–0.23) | <0.001 |
| Heavy proteinuria+ | 0.73 (0.63–0.85) | 0.66 (0.54–0.82) | 0.47 (0.33–0.65) | <0.001 |
| Hospitalized within two years before initiation | 1.91 (1.52–2.39) | 2.77 (1.85–4.13) | 2.41 (1.23–4.69) | <0.001 |
| Inpatient diagnosis of AKI++ | 2.26 (1.97–2.60) | 3.08 (2.47–3.83) | 4.18 (2.78–6.30) | <0.001 |
| Care practices at or before initiation | ||||
| Outpatient visit to a nephrologist+++ | 0.36 (0.31–0.42) | 0.12 (0.09–0.14) | 0.03 (0.02–0.05) | <0.001 |
| Vascular access placement ++++ | 0.52 (0.45–0.60) | 0.26 (0.20–0.33) | 0.10 (0.05–0.19) | <0.001 |
| Inpatient dialysis initiation | 1.76 (1.53–2.02) | 2.71 (2.16–3.41) | 3.12 (2.05–4.73) | <0.001 |
| Inpatient diagnosis of AKI at initiation+++++ | 2.61 (2.21–3.09) | 3.76 (2.99–4.74) | 7.11 (4.70–10.76) | <0.001 |
| eGFR at initiation ≥ 15 ml/min/1.73 m2 | 3.34 (2.74–4.08) | 3.09 (2.32–4.10) | 4.41 (2.87–6.75) | <0.001 |
| Center hemodialysis as initial modality | 2.28 (1.80–3.49) | 4.13 (2.00–8.53) | 5.33 (1.28–22.25) | <0.001 |
Values shown are dds ratio (95% confidence interval); referenct group is persistently low eGFR (Group 1, n=3,520). Analyses are adjusted for patient demographic characteristics, co-morbid conditions, ability to ambulate and transfer, primary cause of ESRD and level of proteinuria (negative, trace,1+, 2+, 3+, 4+ or missing)
AKI, acute kidney injury; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease
Based on 3+ or higher proteinuria (vs. negative, trace 1+ or 2+) on most recent urine dipstick prior to dialysis initiation (available for 4,909 patients)
Among patients hospitalized at least once during the two year period before dialysis initiation
Within two years before dialysis initiation
Among patients who initiated hemodialysis
Among patients who initiated dialysis during an inpatient admission