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 ORIGINAL ARTICLE
Year : 2014  |  Volume : 24  |  Issue : 2  |  Page : 75-81

Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient


1 Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN; epartment of Nephrology, Mayo Clinic Health System; Healthcare Executive, Eau Claire, WI, USA
2 Information Technology, NTEC Solution LLC, Eau Claire, WI, USA
3 Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Correspondence Address:
M. A. C. Onuigbo
Department of Nephrology, Mayo Clinic Health System, Eau Claire, 1221 Whipple Street, Eau Claire, WI 54702
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.127886

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Despite decades of research, a full understanding of chronic kidney disease (CKD)-end stage renal disease (ESRD) progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI) on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD) to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34%) patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92) years. Precipitating AKI followed pneumonia (8), acutely decompensated heart failure (7), pyelonephritis (4), post-operative (5), sepsis (3), contrast-induced nephropathy (2), and others (2). Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.






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Indian Journal of Nephrology
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Online since 20th Sept '07