Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease
Year: 2017
Type: review
Abstract: In patients with advanced (estimated glomerular filtration rate <25 mL/min/1.73 m2) non-dialysis-dependent chronic kidney disease (CKD) the optimal transition of care to renal replacement therapy (RRT), i.e. dialysis or transplantation, is not known. Mortality and hospitalization risk are extremely high upon transition and in the first months following the transition to dialysis. Major knowledge gaps persist pertaining to differential or individualized transitions across different demographics and clinical measures during the 'prelude' period prior to the transition, particularly in several key areas: (i) the best timing for RRT transition; (ii) the optimal RRT type (dialysis versus transplant), and in the case of dialysis, the best modality (hemodialysis versus peritoneal dialysis), format (in-center versus home), frequency (infrequent versus thrice-weekly versus more frequent) and vascular access preparation; (iii) the post-RRT impact of pre-RRT prelude conditions and events such as blood pressure and glycemic control, acute kidney injury episodes, and management of CKD-specific conditions such as anemia and mineral disorders; and (iv) the impact of the above prelude conditions on end-of-life care and RRT decision-making versus conservative management of CKD. Given the enormous changes occurring in the global CKD healthcare landscape, as well as the high costs of transitioning to dialysis therapy with persistently poor outcomes, there is an urgent need to answer these important questions. This review describes the key concepts and questions related to the emerging field of 'Transition of Care in CKD', systematically defines six main categories of CKD transition, and reviews approaches to data linkage and novel prelude analyses along with clinical applications of these studies.
DOI: 10.1093/ndt/gfw357
Institutions: University of California, Los Angeles, The Lundquist Institute, University of California, Irvine, University of California, Irvine Medical Center, VA Long Beach Healthcare System, Harbor–UCLA Medical Center, University of Tennessee Health Science Center, Memphis VA Medical Center, Kaiser Permanente
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Racial and Cardiovascular Risk Factor Anomalies in CKD, G3642266705, Hypothyroidism, Cardiovascular Health, and Survival in Kidney Disease, Institute for Clinical and Translational Science, MALNUTRITION, DIET AND RACIAL DISPARITIES IN CKD, Transition of Care in CKD (TC-CKD), Multilevel Time-Dynamic Modeling of Hospitalization and Survival in Patients on Dialysis
OpenAlex ID: W2588791316