Implication of Trends in Timing of Dialysis Initiation for Incidence of End-stage Kidney Disease

Abstract

In the last 2 decades, there have been notable changes in the estimated glomerular filtration rate (eGFR) at which long-term dialysis is initiated in the US and around the world.¹ For example, according to the nationally comprehensive US Renal Data System registry, the proportion of new patients with end-stage renal disease in the US with an eGFR of 10 to 15 mL/min/1.73 m² at the start of dialysis increased from 10% in 1996 to a peak of 28% in 2010.² Although several previous publications have examined dialysis initiation over time, a key remaining knowledge gap is the distribution of eGFR in the underlying at-risk population from which the end-stage kidney disease (ESKD) cases are derived. Thus, secular trends in the likelihood of dialysis initiation at any given eGFR level could not be defined in previous studies, and the implications of potential trends in changes in the size of the at-risk population on the number of patients with ESKD in the population could not be estimated.